RATES · INSURANCE WORKSHEET

Checking your out-of-network benefits

Use this worksheet when you call your insurance company. The call usually takes 10 to 15 minutes. Enter their answers below, then tap Calculate to see what each session may cost you.

01 — BEFORE YOU CALL

Have your insurance card in hand
Call the member services number on the back
If your card lists a separate behavioral or mental health number, call that one
Ask about "out-of-network outpatient mental health benefits"

02 — DETAILS THEY MAY ASK FOR

Provider: Megan Foret, PsyD, Licensed Psychologist

Session type: Telehealth (video)

NPI: 1538562269

Billing codes I use:

90791 · Diagnostic evaluation (first session)

90834 · Psychotherapy, 45 minutes

90837 · Psychotherapy, 60 minutes

03 — QUESTIONS TO ASK

Enter their answers

The highlighted questions feed the calculator. The rest are good to know.

1. Do I have out-of-network benefits for outpatient mental health?

2. What is my out-of-network deductible, and how much have I met this year?

Out-of-network deductible ($)

Amount already met this year ($)

3. After the deductible, what is my coinsurance (the percentage I pay)?

If they say "we cover 70%," your coinsurance is 30%.

4. What is the allowed amount for codes 90791, 90834 and 90837?

The allowed amount is what your plan uses to calculate reimbursement. It's often lower than the $260 session fee. Ask for all three, and enter the amount for 90834 here.

Allowed amount for 90834 ($)

5. Are telehealth (video) sessions covered out of network?

6. Is there a limit on the number of sessions per year?

7. Do I need pre-authorization or a referral?

8. How do I submit a superbill (online, mail or fax), and is there a filing deadline?

9. What is my out-of-network out-of-pocket maximum?

Date of call

Representative's name

Call reference number

04 · Your estimate

What your sessions may cost

Fill in questions 2 through 4 above, then tap Calculate my cost.

Questions about your results? Bring this worksheet to your free consult and we'll go over it together.

Ready to get started?

Book a free 15-minute consult. If you have Lyra, we'll check your eligibility then too.

Let's talk