5 Quick Questions To Ask About Your Out-Of-Network Benefits

You know you need therapy, but you’re not quite ready to pick up the phone and call. The thought of unpacking and unloading all that is under the surface feels daunting and overwhelming. You wonder if therapy can even help you.

You're worried not only about the therapy process itself but also about the expenses.

The cost of therapy may even stop you from getting the help you need.

We understand. Let us help you.

You can often get some reimbursement even when you see Out-of-Network (OON) providers (like us).  But many of you don’t know you may have this benefit. As an anxiety and trauma therapist providing counseling in Philadelphia, our team feels it is important to provide potential clients with an easy peasy guide to using your out-of-network benefits for counseling. That’s why we put up 5 quick questions to ask when calling your insurance company about your out-of-network benefits.

1.) What is out-of-network deductible?

It is the amount you must pay for out-of-network treatment before your insurance will begin to pay you back for any portion of the costs.

2.) What happens after I meet my deductible?

Finding out how much you’ve already spent will let you know how much more you need to spend in order to meet your out-of-network deductible. For example, if your out-of-network deductible is $1,000 and you’ve already spent $850, you will only need to spend $150 more before your out-of-network benefits kick in.

3.) What is my coinsurance?

Coinsurance is the share of the cost of a covered health care service that you pay after you’ve reached your deductible. It’s usually a percentage of the approved medical expense. Once you’ve met your deductible, you might pay 20% of the cost of the health service or procedure, for instance. Your insurance company would pay the balance.

4.) How do I submit for reimbursement?

We provide receipts/superbills for reimbursement with insurance companies. A superbill is a document your therapist will provide to you that will include dates of service, a diagnosis code, a CPT code, and your therapist’s NPI and EIN numbers. With the superbill in hand, it can be forwarded to your healthcare insurance.

5.) I have a superbill, now what?

Once you have the superbill and you’ve verified all the information is there, you can easily submit it to your insurance. It is important to note that a superbill does not guarantee reimbursement from your insurance company. Reimbursement depends on several factors, including your insurance provider policies.

All insurance plans are different. Have this list of questions handy when calling your insurance company to determine the specifics about your plan.

Read more about out-of-network claims with Reimbursify here.