Getting paid for mental health services can feel like rolling the dice sometimes. You provide excellent care, submit claims, and then wait. Too often, those claims come back denied or delayed because someone skipped proper insurance verification.
Mental health claims get denied at staggering rates. We’re talking 70% in some cases, way higher than most other specialties. But here’s the good news: Many of these denials can be prevented with proper verification upfront and strong denial management processes.
The Real Cost When Verification Goes Wrong
Poor verification creates a domino effect across your entire practice.
Claim denials jumped to 11.8% in 2024, up from 10.2% a few years back. For mental health providers, it’s worse. Back in 2015, 56% of behavioral health claims got denied. By 2020? That climbed to 70%.
Here’s the painful part: about 65% of denied claims never get resubmitted. That’s money you’ll never see. The average provider loses around $5 million annually. Medicare Advantage plans deny 17% of first submissions. Sure, you can appeal and win about 57% of the time, but that eats up hours better spent with patients.
About 30% of these denials could’ve been caught upfront. Inactive coverage. Session limits already hit. Prior auth nobody requested.
Your Verification Checklist
Get the patient’s complete information first. Full legal name, date of birth, address, Social Security number. I know it seems basic, but claims fail constantly because someone used “Mike” instead of “Michael” or transposed two digits in a birth date.
Photograph both sides of the insurance card. That back side has the provider services number. Write down the member ID exactly as shown. Get the group number. For dependents, grab the primary subscriber’s info too.
Ask these questions on every call:
- Is this coverage active today? What are the start and end dates?
- Does the plan cover outpatient mental health?
- Are we in-network with this plan?
- Any visit limits per year or benefit period?
- Do we need prior authorization? If yes, what’s the process?
- Which CPT codes are covered?
- What’s the patient’s responsibility?
- Has their deductible been met?
Get the rep’s name, any reference number, and note when you called. Mental health benefits play by different rules than medical coverage, so specifically ask about behavioral health. If you’re still figuring out how to bill for mental health services, nailing these verification basics becomes critical.
Where Things Get Tricky
Mental health verification throws curveballs that regular medical billing doesn’t. Many plans carve out behavioral health to third-party companies like Optum or Magellan. You call the number on the card, and the person answering literally cannot see the mental health benefits.
Coverage varies wildly even within the same insurance company. I’ve seen two Blue Cross patients where one has unlimited therapy sessions while the other gets capped at 20 visits yearly. Never assume anything based on the carrier name alone.
Telehealth is its own challenge in 2025. Coverage expanded during COVID, but every payer and state handles it differently. Some plans still limit telehealth or require different paperwork. Verify virtual session eligibility separately every time.
Prior authorization keeps getting more complicated. Some plans want it after certain sessions. Others demand it from visit one. Timing matters too. Submit a request two days before the appointment, and it might not get approved in time.
Best Times to Call and What to Document
Call between 8:00 and 10:00 in the morning. Reps are fresher, less slammed, and hold times are shorter. Skip lunch hours and late afternoons.
Stuck in an automated menu? Keep hitting 0 or # until a human picks up. Works about 80% of the time.
Verify every new patient. That 15-minute call saves months of chasing payments later. For existing patients, reverify yearly. Medicare Advantage or employer plans? Check quarterly because those change constantly.
Write down everything. When you called, who you spoke with, their ID number, confirmation numbers, and coverage details. Your billing team needs this for clean claims, and you need proof if the insurer later disputes what they said. Understanding who can bill for mental health services helps clarify which credentials require extra documentation during verification.
| What to Verify | Details Needed | Red Flags |
| Patient Info | Legal name, DOB, address, SSN | Nicknames, outdated addresses |
| Coverage Status | Active dates, termination dates | Gaps, pending start dates |
| Network Status | In-network for your NPI | Out-of-network status |
| Benefits | Visit limits, frequency caps | Carved-out benefits |
| Authorization | Pre-auth requirements, approved sessions | Expiring authorizations |
| Patient Cost | Copay, remaining deductible, coinsurance | High unmet deductible |
When Technology Helps (and When It Doesn’t)
Automated eligibility tools are useful but don’t replace phone calls for mental health. Online portals give you the basics but miss behavioral health specifics, especially with carved-out plans. The system might say “coverage active” while missing that mental health needs separate authorization or the patient has exhausted their visits.
What works: use appropriate billing software for initial demographics and active coverage checks, then call to confirm mental health details. Some practices split this work. Admin staff runs online checks, clinical staff makes verification calls. Faster and thorough.
Make sure your EHR checks mental health benefits specifically, not just general medical coverage. Many systems default to medical verification, completely missing carved-out behavioral health requirements.
Common Mistakes to Avoid
Watch out for these verification pitfalls:
- Assuming coverage based on previous patients with the same insurer
- Skipping reverification for established patients
- Not documenting the representative’s name and call details
- Forgetting to ask about carved-out behavioral health administrators
- Missing telehealth-specific coverage requirements
- Ignoring pre-authorization deadlines
- Failing to confirm CPT code coverage for your specific services
One mistake I see constantly: practices verify medical eligibility but never ask about mental health carve-outs. Then they’re shocked when claims get denied despite “active coverage.” Always dig deeper.
Setting Up Systems That Work
Create a checklist everyone follows. Same questions, same format, every time. Update it quarterly because payer policies shift constantly.
Train your front desk beyond just onboarding. Teach them common issues, payer quirks, and mental health parity law updates. The 2024 parity rules require employer plans to track claims data and denials. When your team knows this, they can challenge unfair denials.
Run monthly audits on verification records. Random checks spot gaps or patterns. Maybe a particular plan always needs an extra step nobody’s catching. Or a rep who consistently leaves out important information.
If verification is drowning your staff, bring in help. Specialized mental health billing services know the rules, stay current on changes, and often pay for themselves through fewer denials and faster payments.
Moving Forward
Insurance verification takes patience. Every unverified patient gambles with your revenue. But practices that get serious about verification see real changes. Cleaner claims. Fewer denials. Predictable cash flow.
Mental health billing won’t get simpler anytime soon. But your verification process can get tighter. Stay current on policy changes. Train your people. Document thoroughly. When you nail verification, it stops being a headache and becomes the foundation for a stable, growing practice.