Verify benefits before the first session by calling the behavioral health number on the client's card and asking ten questions: eligibility, deductible and amount met, copay/coinsurance for CPT 90837/90834, telehealth coverage by place of service, session limits, prior authorization, carve-out entity, claims address, and EAP requirements. Then record the reference number for the call.
"I have Aetna" tells you almost nothing: not whether the plan is active, not what the client will owe, not whether their behavioral benefits even run through Aetna. Twenty minutes of verification before intake prevents the surprise bill and the denied claim, the two worst conversations in private practice.
The 10-question verification call script
Run this on the behavioral health line before intake. It takes 10–15 minutes and produces everything your first claim needs, which is why the answers slot straight into the first-claim checklist.
BEFORE DIALING, HAVE: client's full name, DOB, member ID, your NPI and tax ID. Call the BEHAVIORAL HEALTH number on the card if one exists.
"Hi, I'm [NAME], a [LICENSE TYPE] provider, NPI [NPI], verifying outpatient behavioral health benefits for a member. Member ID [ID], name [CLIENT NAME], date of birth [DOB]."
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ELIGIBILITY - "Is the plan active today, and what is the plan year or renewal date?"
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CARVE-OUT - "Are outpatient mental health benefits managed by [PAYER] directly, or by another entity such as Optum, Carelon, or Evernorth? If another entity, what is their provider phone number and claims address?"
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NETWORK STATUS - "Am I showing as in-network for this member's specific plan? I'm NPI [NPI], tax ID [TIN]."
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DEDUCTIBLE - "Is there a deductible for in-network outpatient behavioral health? How much is it, how much has been met, and do office visits apply to it or just the copay?"
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COST SHARE - "Once the deductible is met, what is the copay or coinsurance for CPT 90837 and 90834, office setting?"
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TELEHEALTH - "Are those codes covered via telehealth with place of service 10 - client at home - with modifier 95? Same cost share as in office? Audio-only covered?"
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SESSION LIMITS - "Is there a visit limit per year for outpatient behavioral health, and how many visits have been used?"
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AUTHORIZATION - "Is prior authorization or a registration required for routine outpatient therapy? At what visit count, if any, does authorization kick in?"
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EAP - "Does this member have an EAP benefit that must be used first or that covers initial sessions? If yes: how many sessions, is an authorization code required, and does the EAP bill to a different entity?"
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CLAIMS + REFERENCE - "What is the claims submission address or payer ID for these benefits? And can I get a reference number for this call and your first name?"
LOG: date/time, number dialed, rep name, reference #, and every answer above. Keep it in the client's file next to the card copy.
CLOSING LINE TO USE WITH THE CLIENT: "Based on what [PAYER] quoted on [DATE], your estimated cost is $[X] per session [after $[Y] remaining deductible]. That's their quote - final amounts depend on claim processing, and I'll flag anything that comes back differently."
Why isn't "I have Aetna" enough?
Because the brand on the card often isn't the company managing therapy benefits. Behavioral health is the most carved-out benefit in American insurance: the medical plan delegates mental health to a specialty company that runs its own network, its own fee schedule, and its own claims system. You can be in-network with the medical brand and out-of-network with its behavioral carve-out, or vice versa.
| Card says | Behavioral benefits usually managed by | Where you verify |
|---|---|---|
| UnitedHealthcare | Optum Behavioral Health | Provider Express |
| Anthem BCBS | Carelon Behavioral Health (many plans) | Availity / Carelon portal |
| Cigna | Evernorth Behavioral Health | CignaforHCP |
| Aetna | Aetna behavioral (in-house) | Availity |
| Any employer plan | Possibly a separate EAP vendor first | The EAP number on the card |
The carve-out decides everything that matters to you: network status, rate, authorization rules, and the claims address. A therapist paneled with Optum is in-network for most UHC members, but a self-funded employer plan on a UHC card can route behavioral to a different vendor entirely. The only way to know is to ask, on every plan, every time.
Look at the back of the card first. A separate "Mental Health / Behavioral Health" phone number is the tell that benefits are carved out. Call that number, not the general member services line: ten minutes on hold with the right entity is worth more than two quick minutes with the wrong one.
When should you verify, and re-verify?
Before the first session, always; then again each January and whenever the client changes jobs. Coverage churns at year-end: deductibles reset, employers switch carriers, and the plan that paid cleanly in December can deny in January. A quick portal eligibility check at reintake beats discovering a lapsed plan after four sessions.
Portals handle the easy half. Availity, Provider Express, and CignaforHCP will confirm eligibility, deductible, and often the copay in under five minutes. The phone call earns its keep on the questions portals answer badly: carve-outs, telehealth place-of-service rules, session limits, and EAP-first requirements.
Portal eligibility can look clean and still hide an EAP-first requirement. Some employer plans route the first several visits through an EAP authorization, with the EAP vendor, not the medical plan, as the payer of record, and every claim denies (six sessions of them, in a common version of this story) until someone asks about the EAP. Question 9 on the script above exists for exactly this.
What do the telehealth questions actually determine?
Whether your claim form matches how you actually see the client, and at what rate. Telehealth to a client at home bills place of service 10; telehealth to a client anywhere else bills POS 02; office sessions bill POS 11. Payers can cover these differently, and CMS pays POS 10 at the higher non-facility rate, a pattern commercial payers largely follow. Ask about the specific POS you'll bill, with the modifier (95 for audio-video), not just "is telehealth covered." The full mapping is in telehealth POS codes for therapy.
How do you quote costs without promising them?
Quote the numbers, attribute them, and attach the payer's own caveat. Every eligibility rep closes with a version of "this is a quote of benefits, not a guarantee of payment," so borrow it. Tell the client: "I verified your benefits today; based on what [PAYER] quoted, you'd owe about $40 per session after your deductible, which has $250 left. That's their quote, and final costs depend on how the claim processes."
That sentence gives the client a real number with its source attached, and it never promises what you don't control. The same discipline applies to yourself: write down the reference number the rep gives you. If the claim later denies against the quoted benefits, that reference number is what turns your appeal from he-said-she-said into a documented misquote. If you're not yet paneled with this client's carve-out at all, a single-case agreement is sometimes the bridge.
Some practices batch verification into their intake workflow; credentialing platforms like paneled.ai exist because the payer-facing plumbing (networks, carve-outs, claims addresses) is the part of therapy no graduate program covers. The script gets you through it one client at a time.
Common questions
- How do I verify a client's mental health benefits before the first session?
- Call the behavioral health number on the back of the client's card (or check the payer portal), confirm eligibility is active, then ask ten specific questions: deductible and how much is met, copay or coinsurance for outpatient behavioral health, telehealth coverage and place of service, session limits, prior authorization, whether behavioral health is carved out to another company, and EAP requirements. Document the call's reference number.
- What is a behavioral health carve-out and why does it matter for therapists?
- A carve-out means the medical plan delegates mental health benefits to a separate company: UnitedHealthcare plans typically route behavioral health to Optum, many Anthem plans to Carelon Behavioral Health, and Cigna plans to Evernorth Behavioral Health. It matters because the carve-out company, not the card's brand, decides whether you're in-network, what it pays, and where claims go.
- Can I tell a client exactly what therapy will cost after verifying benefits?
- You can quote what the payer told you (copay, coinsurance, remaining deductible), but frame it as a quote, not a promise. Every payer's eligibility line ends with some version of "a quote of benefits is not a guarantee of payment." Say the same thing to clients: "Based on today's verification, your cost should be about $X per session, subject to your plan's final processing."
- What is an EAP-first requirement in therapy benefits?
- Some employer plans require or offer a set number of Employee Assistance Program sessions (often 3 to 8, free to the client) before or alongside regular outpatient benefits. EAP sessions bill differently (an authorization code, sometimes a different payer entity and rate), so ask on every verification call whether EAP applies and whether an EAP authorization exists for your client.
The paneled.ai team · Credentialing specialists. We file and track insurance credentialing applications for behavioral health providers every day — these guides come from what we see go wrong (and right) in real applications.