Out-Of-Network
Insurance Benefits
How do I verify my “Out-Of-Network” insurance benefits?
Many health insurance plans offer coverage to reimburse clients for qualified healthcare expenses they paid directly to providers who do not have a contract with the insurance company. To verify the details of your specific coverage, contact your health insurance carrier and ask them the following questions:
- Do I have out-of-network outpatient mental health coverage?
- Am I able to use these benefits for telehealth?
- Do I need a referral from an in-network provider to see someone out-of-network?
- Is there pre-authorization required? If so, what information do you need for this? Is there a specific form that needs to be filled out?
- Is there a session limit per year?
- What is my out-of-network deductible?
- How much of my deductible has been met this year?
- What percentage of outpatient psychotherapy sessions are covered per session?
- What amount will I be reimbursed for the following services with a licensed professional counselor?
- CPT Code 90791 (initial diagnostic evaluation) at a fee of $550.
- CPT Code 90837 (subsequent psychotherapy sessions) at a fee of $400 per session.
- How do I submit claim forms for reimbursement?
- How long does it take for me to receive reimbursement?
Insurance companies with out-of-network coverage allow clients to submit their claims directly. There are also third-party services like Reimbursify and Mentaya that can be used to simplify the reimbursement claim process (for a fee).