How to use Out-of-Network Benefits for Therapy
How to use Out-of-Network Benefits
As an Out of Network Provider, many insurance companies will reimburse for my services! This is a great option if you are unable to pay out of pocket. I felt this was an important post as more Therapists are choosing to opt out of paneling with Insurance Companies.
When using Out-of-Network benefits clients will pay for services up front. Once services are paid, your therapist will provide a super-bill (receipt) for services which you can present to your insurance company for reimbursement. Every therapist may choose to set this up differently: for example providing a receipt after each visit, or potentially on a monthly basis.
How do I know if my insurance company will reimburse me?
Call your insurance company to verify: The best way to be absolutely sure of your benefits is to call your insurance company member services line (this will typically be on the back of your insurance card) and ask:
What is my out-of-network deductible for outpatient mental health?
How much of my deductible has been met this year?
What is my out-of-network coinsurance for outpatient mental health?
Do I need a referral from an in-network provider to see someone out-of-network?
Below are the codes that will be needed to see what exactly your insurance company is willing to reimburse for each type of session. Please let me know if you have any questions!
Intake: Psychiatric Diagnostic Evaluation - Code: 90791
Psychotherapy: 45 Minute - Code: 90834
If you are told that you do have out-of-network benefits… Be sure to get details on how they want you to request reimbursement (Is there an email you send the bill to? Do you have to fill out a form?). I always recommend that you note the date & time of the call as well as the name of the person you spoke to.
So many potential clients I speak to didn’t know that this was an option for them! Knowing how to Utilize Out-of-Network benefits provides individuals with the freedom to have more autonomy over their health (whether that be for therapy or another healthcare need!)
