NYC Therapy + Wellness
Insurance Benefits Q&A
Please enter your insurance information below so that we may file claims on your behalf.
Name *
First, Last
Your answer
Does your plan include "out-of-network" coverage for mental health? *
Is there an annual deductible for out-of-network mental health benefits? If so, how much? *
Your answer
How much of your deductible have you met? (If there is no annual deductible, please type "N/A" below)
Your answer
Is there a limit on the number of sessions your plan will cover per year? If so, how many?
Your answer
Is there a limit on out-of-pocket expenses per year?
Your answer
What is the co-insurance percentage for mental health services that your plan will cover? (40-100%) *
Your answer
Does your plan require pre-authorization for psychotherapy? Check all that apply. *
Required
What is the policy year (i.e. Jan 1 – Dec 31; July 1- June 30)?
Your answer
Does your plan require a referral for psychotherapy?
What is the Usual, Customary, and Reasonable Fee for New York City/County/Area Code 10010?
Your answer
What is the Payer ID for your insurance plan? (i.e. 77624) *
Your answer
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