Although most insurance plans make 20 to 30 annual mental health visits available in their contracts with employers, they may deny coverage after approximately eight to 10 visits due to their determination of "medical necessity." The companies typically ask for an outpatient treatment report, or OTR, after several visits.
If the request for services is still denied, you have a right to appeal. But listen carefully: According to the Mental Health Legal Advisors Committee, a state-funded advocacy group based in Boston, Mass., your therapist must tell the insurance company's utilization reviewer and doctor that he or she will not accept a denial of services or a reduction in services.
If you can afford it, your treatment can continue during this process. If the appeal is denied, you can continue treatment with your therapist, and the two of you negotiate the fee. Goldberg notes that the therapist cannot charge you more than what your insurer was paying if your approved sessions have been used up.