OUT-OF-NETWORK (OON) INSURANCE
This page is intended to help inform you about how to use out-of-network coverage to help pay for therapy if you choose to do so. While it is your responsibility to work with your insurer to pursue claims related to your therapy, we are available to answer questions and support you.
Out-of-Network Insurance FAQs:
What is out-of-network coverage?
Some insurance plans cover services provided by therapists who are not contracted directly with them (in-network). This is called “out-of-network” coverage.
How do I know whether I have out-of-network coverage?
Your insurer should have provided you with documentation about your plan that tells you whether you have out-of-network benefits. If you do not have or do not understand this documentation, you should call them to ask.
What should I ask my insurance company about my out-of-network benefits?
Does my plan cover out-of-network providers?
Is there a deductible that needs to be met before my plan will pay for out-of-network mental health care?
How much is that deductible?
How much will my plan cover for a therapy appointment with a $180/session fee?
What is the process for submitting out-of-network claims?
What are the CPT codes for therapy?
Individual: 90837
Couples: 90847
Extended sessions (rare): 99354
What are the common CPT codes for psychiatry?
Intake: 99204, 90833, and 96127
Follow-up: 99214, 90833, and 96127
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To use your out-of-network insurance benefits:
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Inform your provider that you would like to submit claims to your insurance company. They will discuss with you whether or not your treatment qualifies for insurance usage.
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Pay for your sessions at the time of service, using a debit, credit, HSA, or FSA card.
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You will begin to receive a link to a “superbill” by email on the 10th each month until you discontinue services.
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Submit your “superbills” to your insurance company using their submission process for out-of-network claims.
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If your sessions are covered, you will receive a check from your insurance company.