Guide for Out of Network Benefits

If you have Out-of-Network benefits, this guide will help you get the information you need to submit a reimbursement claim with your insurance company. The simplest way to get this information is to call your insurance company and ask the following questions. You can usually find the number on the back of your insurance card.

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1. Do I have Out-of-Network benefits?

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*If they answered “no”, you do not have out-of-network benefits, and the remaining questions are not applicable because your insurance company will not provide reimbursement for your sessions.*

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2. Do my Out-of-Network benefits cover outpatient mental health services (also known as behavioral health)?

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3. My therapist uses the following CPT code, can you tell me if it is covered?

    90834- Psychotherapy for 45 minutes

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3a. Is prior authorization required? If so, write down the details.

 

4. Are telehealth sessions covered with my out-of-network benefits? CPT code: 90834-95 (modifier 95)

 

5. Do I have a deductible? (A deductible is the amount you will pay out of pocket before your insurance company will provide reimbursement.)

 

6. How much does my plan cover? (This might be called your co-insurance or member cost-share, and it is often calculated on a percentage basis).

 

7. How do I submit the claim?

 

8. Do I need a special form to submit along with my superbill / medical receipt?

 

9. How will I be reimbursed?