It means I am not contracted with your insurance company, so you pay for sessions directly. Some plans still reimburse you for part of the cost of out-of-network care. You have to ask for it and submit the paperwork, and this page walks you through how.
A quick, honest note: I cannot guarantee that your plan will reimburse you. What I can do is make it as easy as possible to find out and to file.
What does "out-of-network" mean for therapy?
What it means.
using your benefits
You pay upfront. Your insurer may pay you back.
You pay the full session fee at the time of service. Each month, my system can send you a superbill, which is a detailed receipt with everything your insurer needs.
You submit it, and depending on your plan, they reimburse you directly for a portion of the cost. There is no billing department to argue with, and no diagnosis living in an insurance file against your wishes.
KNOWING YOUR BENEFITS BEFORE YOU BEGIN TAKES ONE WORRY OFF THE TABLE.
Do I need a referral from an in-network provider to see someone out-of-network?
Do I have a copay or coinsurance for out-of-network outpatient mental health? How much?
Is my plan per calendar year or per benefit year, and what are the coverage dates?
Do I have a deductible? How much is it, and how much has been met this year?
Do I have out-of-network benefits for outpatient behavioral health therapy?
TO ASK YOUR INSURER:
Ask your insurer for a quote for outpatient, out-of-network behavioral health benefits.
What I need to know?
Deductible
The amount you pay before your insurer starts paying for treatment. Submitting superbills helps you reach it.
Coinsurance
The percentage of a covered service you pay, say 20%, after you have met your deductible.
Copay
A set amount your insurer subtracts before applying their percentage. It affects how much you are reimbursed.
Superbill
An itemized receipt for a session with an out-of-network provider that you submit for possible reimbursement.
Reimbursement
Based on your insurer's "reasonable and customary" price for the service codes, which may be more or less than the fee you paid.
