What is Out of Network Therapy?
Updated: Apr 9, 2021
Seeking therapy with an "Out-of-Network" provider may seem daunting, but it is often a great way to find the therapist of your choice with little to no wait time for a first appointment. Therapists, especially psychologists, who accept insurance tend to be few and far between, particularly if you live near a major city. Those who do are usually not accepting new patients or have extremely long wait times.
If you're looking for therapy with a provider who is not in your insurance network, you will owe the full cost for the session at the time of the appointment. However, your insurance company may reimburse much of the cost of your Out of Network session.
How Do I Know if I Qualify?
Check your "Summary of Benefits." This is typically included in the packet you received when you signed up for your insurance, and can also be found on your insurance portal online.
Call your insurance company using the number provided on the back of your card. Here are a few helpful questions to ask:
What is my out of network deductible for outpatient mental health? (Your deductible is the cost you pay before you can be reimbursed)
What is my reimbursement rate?
What percentage will I owe?
Do I need authorization or referral?
Are the following CPT codes covered Out of Network: 90791 (Diagnostic Interview) 90834 (Individual Therapy)?
How do I submit a claim form for reimbursement?
How will I receive my reimbursement?
Once you've met with your therapist, you will receive what is called a Superbill. This is a document that includes all the information you will need to submit your claim. This is usually done at the end of each calendar month.
And that's it!