How to use insurance for Mental Health
Navigating health insurance can feel confusing and even stressful, especially when all you want is to get the mental health support you need.
Our goal is to make this process easier, clearer, and more empowering so you can focus on what matters most, your well-being.
We accept most major insurance plans. If this all feels too overwhelming, you can text or call us anytime or submit your information online, and our team will verify your benefits for you. If you prefer to check your own benefits, here is a simple step-by-step guide to help you understand your mental health insurance coverage.
1. Know the Key Terms
Before you call your insurance company, it helps to understand a few common words.
What is a Deductible?
The amount you must pay out of pocket each year before your insurance starts paying for services.
What is a Copay?
A set dollar amount you pay at each visit (for example, $25).
What is a Coinsurance?
A percentage of the cost you pay after meeting your deductible (for example, 20% of the total amount we will bill for the visit).
In-Network Provider
A clinician/provider/Doctor who has a contract with your insurance company and offers services at a lower, agreed-upon rate.
Out-of-Network Provider
A clinician who does not have a contract with your insurance. You may still be reimbursed for part of the cost, but you will need to request reimbursement directly from your insurance and out-of-pocket expenses are higher.
2. Call Your Insurance Company or Check Your Online Portal
When you contact your insurance provider, ask these specific insurance questions to understand your mental health benefits.
Questions to ask:
Do I have mental health coverage?
Is Upper Echelon Psychiatry/ Davonna Wilson, APRN
(Provide our NPI: 1467693366) in network with my plan?
If not, do I have out-of-network benefits, and how do they work?
What is my deductible, and how much of it have I met this year?
What is my copay or coinsurance for outpatient mental health services?
Does my copay count toward my deductible?
Do I need a prior authorization for mental health visits? If you do, do not worry we can process this for you.
Are telehealth visits covered the same as in-person sessions?
Is there a limit on the number of sessions per year?
How do I submit a claim for out-of-network reimbursement?
Tip: Write down the representative’s name and ask for a reference number for your call. It can make things easier later if there is a billing question.
3. Understand Your Costs
Here is how insurance billing typically works for mental health services at Upper Echelon Psychiatry.
Your cost will depend on your plan’s deductible, copay, and coinsurance.
Example:
If your deductible has not been met, you will likely pay the full allowed amount per visit.
If your deductible has been met, you will usually pay just a copay (for example, $25 or $35).
Once you reach your out-of-pocket maximum, your insurance should cover 100% of eligible costs for the rest of the year.
4. In-Network vs. Out-of-Network
Choosing an in-network mental health provider often means lower costs because your insurance company has negotiated discounted rates.
If you choose an out-of-network provider, your insurance may still reimburse part of the cost, but:
You will likely pay a higher portion upfront.
You may need to submit a claim manually.
Reimbursement depends on your plan’s allowed amount.
To find out exactly how much your session will cost, ask your insurer:
“What is the allowed amount for CPT (billing) code 99214 with provider NPI 1467693366?”
5. Telehealth and Out-of-Network Coverage
Many insurance companies now cover telehealth mental health services the same way they cover in-person visits.
To confirm, ask your insurer:
“Will my plan cover out-of-network telehealth sessions for mental health?”
At Upper Echelon Psychiatry, we provide secure telehealth appointments across multiple states to make care accessible wherever you are.
6. When It Feels Overwhelming
Understanding your insurance coverage can feel like learning a new language, and you do not have to do it alone.
If you ever feel stuck or unsure where to start:
Text or call us for help verifying your benefits 888-508-4068, or
Submit your information through our website (become a new patient button on top of this page), and we will take care of the rest.
We are here to help you understand your health insurance for mental health services and help you ensure there are no surprises when it comes to cost.
