How to Pay for Therapy Using Out-of-Network Benefits

Many people find that they prefer to work with an out-of-network Therapist.  Some people find they can actually save money by doing this.  If you have been considering this option, read on for tips on how you can do that.

Check Your Out-of-Network Benefits

The very first step in using your out-of-network benefits is to check on them with your insurance company.  Be specific and check the benefits for your policy.  Just because you have the same insurance company as another person doesn't mean your policies are the same so be certain to check that. You might be able to find this information in your member information packet in the Summary of Benefits.  You might also find them on your insurance company's website.

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Verify With Your Insurance Company

The next step, if you want to be absolutely certain, is to call your insurance company member services line.  You'll want to ask the following

  1.  What is your out-of-network deductible?
  2.  What is your out-of-network coinsurance for outpatient mental health?
  3. Do you need a referral from an in-network provider to see someone out-of-network?
  4. How do you submit a claim for reimbursement?

Be certain to ask all four questions to be fully informed.

Get a Superbill

When you see your therapist, ask them for a superbill.  This is a form that they can print off for you that you send to your insurance company monthly that will tell them how many sessions you've had and the fee.  Most therapists will be able to provide you with this.  Of course, this too is worth checking into in advance.

Reimbursement Time!

You will pay your therapist their entire fee at the time of service.  Then, once your insurance company receives your claim, if you have done all the work to ensure you are covered with out-of-network benefits, you should receive a check from them for the percentage they reimburse.