Want to get reimbursed for the investment you make in therapy?
A lot of people don’t realize this, but insurance companies offer two types of benefits: in-network and out-of-network. You’re probably familiar with the in-network benefits where your doctor or therapist submits claims to insurance on the backend and then insurance pays them for the services. Out-of-network benefits are where you pay the doctor or therapist directly, then you submit the claim to insurance, and insurance reimburses you.
Here is an example of how it works:
Let’s say your out-of-network deductible is $2,000, you’ve already paid $1000 on it, and your out-of-network coinsurance is an 80/20 split.
In this scenario, you would pay for about 6 therapy sessions at $165. After that, your insurance would send you a check for $132 per session. So in the end, you only pay $33 per session.
How do I figure out if I have out-of-network benefits?
Step 1:
Call the number on your insurance card and ask to speak to a representative. Ask the following questions:
Do I have out-of-network benefits with my plan?
What is my out-of-network deductible?
How much of this deductible have I already paid?
How much will my plan cover for Telehealth outpatient mental health services after I meet my deductible?
Where do I find the necessary forms to submit an out-of-network claim?
Where do I send the paperwork?
They usually want you to submit a claim form (which they provide) and a super bill (which I provide to you). The forms require simple information, such as who the therapist was, the date of service, diagnosis, etc. Plans will either have you mail the claim to them or submit it online.
Step 2:
Pay for therapy out-of-pocket
Submit the forms to insurance
Receive your reimbursement!
*Note: every insurance plan is different, and I cannot guarantee that you have this benefit nor that your insurance company will cover services.