Mental Health Claims

In most cases, if you choose to see an in-network provider, you have a cost-share such as a copay, or a set amount you pay per visit. An in-network provider is a health care professional or facility that contracts with EmblemHealth and ConnectiCare. They provide covered products and services to members. You'll usually pay less when you use doctors, hospitals, and others in the network.

If you choose to get care with an out-of-network mental health provider, you may still get reimbursed,* or repaid, for some of your out-of-pocket costs.

To get reimbursed, you must download these materials, including a claim submission form. Then, follow the steps below:

• After your next session, have your provider fill out Part II of the form and give it back to you.
• Under Assignment of Benefits, check off the “No” box.
• Sign and date your name in the three locations indicated.
• Fill out Part I of the form completely. Do not leave anything blank.