Out of Network Reimbursement Questions

Upon request I can provide clients with a receipt (called a superbill) that you can submit to your insurance company for partial or full out of network (OON) reimbursement. Reimbursement is not guaranteed and details must be worked out between you and your insurance provider. I do not submit claims directly to insurance companies on an OON basis, so these are questions meant to assist you in determining how best to work with your insurance company if you are seeking OON reimbursement.

If you are interested in learning about your out of network (OON) benefits, I suggest that your call your insurance and ask the following questions:

• Does my plan cover OON providers for mental/behavioral health services?

• What is the reimbursement rate for OON providers within my plan? Specifically, what is the OON reimbursement rate for the CPT code 90837-95? (The code for a standard Telehealth therapy session)

• How many therapy sessions does my plan cover for OON behavioral health providers? (Is it unlimited or is there a maximum?)

• What is the process for submitting claims for out of network reimbursement?  (Some plans have portals, some require physical copies to be mailed in, etc.)  How long will it take to be reimbursed for sessions after I have submitted my claims?

• What is my out of network deductible and have I met it yet this year?

• Will my OON sessions be applied to a separate OON deductible?

• Is approval required from my primary care physician?

Note: Medicaid will not reimburse for out-of-network providers.