Out-of-Network coverage instructions
What does out of network mean?
Providers that are out-of-network are those that do not participate in that health plan's network. We are not contracted with the health insurance plan to accepted negotiated rates. This means that our clients pay the full service rate up front. However, some insurance plans have out-of-network benefits (typically PPO plans). These plans allow you to file a claim with your insurance company and they reimburse you for some of the money you spent.
Here are two great ways to learn more about your Out-of-Network coverage!
For the most accurate answers, we recommend calling your insurance company to see if you have out-of-network benefits. If you do, they typically will reimburse you for 60-80% of the cost of each session. The best way to get in contact with someone from your insurance company is to call the number on the back of your health insurance card listed under Member Services.
If you are open to paying a small fee, we recommend Reimbursify to check benefits, file claims and deal with any insurance headaches!
If you call your insurance company, you should ask the representative the following questions:
Do I have out-of-network outpatient mental health coverage?
Am I able to use these benefits for telehealth and in-person appointments?
What is my out-of-network deductible?
How much of my deductible has been met this year?
Do I need a referral from an in-network provider to see someone out-of-network?
How much will I be reimbursed for a 50 minute psychotherapy session (CPT/Service code: 90834)?
How do I submit claim forms for reimbursement?
How long does it take for me to receive reimbursement?
Since we are an out of network provider, we do not bill any insurance, nor do we submit out of network claims. Since each insurance company is unique, it is up to you to know your benefits and to submit for reimbursement if you so choose.
If appropriate, we will provide you with monthly invoices called a “superbill” that will include all of the necessary information for your claims to be processed. This will be automated on the last day of each month and sent through the Simple Practice Client Portal.
Benefits of not providing insurance support
You get to work with a therapist that is allowed to use the best therapeutic approaches to help you meet your goals. Your length and/or quality of care will not be hindered by what your insurance does or does not cover.
You and your therapist are the only people that will know you're in therapy (apart from anyone in your personal life that you've told). You do not have to worry about having medical determinations on your records or having outside parties look at your session details.
You get a therapist that is engaged and ready to support you. Insurance companies are often very difficult to work with and can take up long periods of agonizing admin time. Without this frustration, our therapist(s) are able to readily available to support you in your process of growth.