NYC Therapy + Wellness

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Insurance Benefits Q&A

Please enter your insurance information below so that we may file claims on your behalf.

Name *

First, Last

Does your plan include "out-of-network" coverage for mental health? *

Yes

Is there an annual deductible for out-of-network mental health benefits? If so, how much? *

How much of your deductible have you met? (If there is no annual deductible, please type "N/A" below)

Is there a limit on the number of sessions your plan will cover per year? If so, how many?

Is there a limit on out-of-pocket expenses per year?

What is the co-insurance percentage for mental health services that your plan will cover? (40-100%) *

Does your plan require pre-authorization for psychotherapy? Check all that apply. *

For a 45-minute session (CPT code 90834)

For a 60-minute session (CPT code 90837)

For couples/family therapy session (CPT code 90847)

NO PRE-AUTHORIZATION REQUIRED

Required

What type of insurance? *

PPO

POS

HMO

EPO

Managed Care

Other:

What is the policy year (i.e. Jan 1 – Dec 31; July 1- June 30)?

Does your plan require a referral for psychotherapy?

Yes

Clear selection

What is the Usual, Customary, and Reasonable Fee for New York City/County/Area Code 10010?

What is the Payer ID for your insurance plan? (i.e. 77624) *

Submit

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