Before anyone signs an admission agreement, call the member services or behavioral health number on the insurance card. Ask the 10 questions below about one specific program and one level of care, and fill in the call log as you go. If a bill or denial shows up later, those notes are your record.
A program saying “we take your insurance” isn’t enough, because its benefits check isn’t a promise to pay.
What questions should we ask the insurance plan?
Insurance call checklist: 10 questions and call log
- Have ready
- The 10 questions
- Call log
If you only get through three, make them 1, 5 and 9. Out of network, a program can bill you for the gap between its charge and what the plan allows,1 and that gap doesn’t count toward your out-of-pocket maximum.2 Even an approved prior authorization isn’t a guarantee of coverage.3 More on in-network vs out-of-network rehab and how plans approve treatment days.
How do we get clear answers?
If the plan isn’t yours, HIPAA lets it share what’s relevant to your role in paying when the member doesn’t object, but it doesn’t have to.4 It may ask for the member’s OK on the call or a signed form, so have your loved one nearby if you can.
Also ask for the medical necessity criteria the plan uses to approve days. The federal parity law requires the plans it covers to share these on request,5 though it doesn’t apply directly to small-employer group plans.6
Frequently asked questions
What if the plan and the program tell us different things?
Go with the plan’s written answer, and ask the program to explain the difference before you sign.
What if my loved one has no insurance?
Ask each program for a written good faith estimate. When you aren’t using insurance, providers usually must give one if you ask, or if care is scheduled at least 3 business days ahead.7
Sources
- HealthCare.gov — Balance billing (glossary). healthcare.gov/glossary/balance-billing/ — accessed Oct 2026
- HealthCare.gov — Out-of-pocket maximum/limit (glossary). healthcare.gov/glossary/out-of-pocket-maximum-limit/ — accessed Oct 2026
- HealthCare.gov — Preauthorization (glossary). healthcare.gov/glossary/preauthorization/ — accessed Oct 2026
- eCFR — 45 CFR § 164.510(b), Uses and disclosures for involvement in the individual's care (HIPAA Privacy Rule). ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/s… — accessed Oct 2026
- Centers for Medicare & Medicaid Services — Fact sheet: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). cms.gov/newsroom/fact-sheets/mental-health-parity-and-addiction-equity… — accessed Oct 2026
- Centers for Medicare & Medicaid Services — The Mental Health Parity and Addiction Equity Act (MHPAEA). cms.gov/marketplace/private-health-insurance/mental-health-parity-addi… — accessed Oct 2026
- Centers for Medicare & Medicaid Services — What is a good faith health insurance estimate? cms.gov/initiatives/your-patient-rights/medical-bill-rights/get-help/m… — accessed Oct 2026