Insurance Benefits 

Verification Form

If you have an HMO or EPO insurance plan, Medi-Cal,or Medicare, my services are NOT covered by your insurance. Please do not submit this form. I am an out-of-network provider for all other PPO insurance plans.


If you have a PPO insurance plan with out-of-network benefits, it may cover my services. I can verify your insurance benefits in advance and let you know what the expected insurance benefit may be. All clients regardless of insurance coverage pay their services fees on the day the service is provided. If your insurance covers my services, my insurance billing company will bill your insurance provider on your behalf. Any benefits paid to you by your insurance company will be mailed to you directly. I cannot guarantee that your insurance will reimburse you for any of my services even if it is covered by your policy.

Insurance verification typically takes one business day. If your request is submitted in the afternoon on Friday or over the weekend, you will not receive a response until Monday afternoon. I will contact you with the results and next steps by email. If you would like me to verify your coverage, and obtain the reimbursement rate you may receive, please complete and submit the following information. All fields are required for processing.

Thank you! I look forward to working with you.

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Serving California & Oregon via telehealth sessions (phone or video calls).

Tel: (888) 478-6658​

If you are in crisis, call the National Suicide Prevention Lifeline, a free, 24-hour hotline, at (800) 273-8255. If your issue is an emergency, call 911 or go to your nearest emergency room. I do not provide emergency services.

© 2018 by Michael O'Brien. All Rights Reserved.