Navigating out-of-network benefits can be confusing. Ask your insurance provider about coverage, costs, and claim submission procedures for clarity.

Out-of-Network Reimbursement
If you have a PPO insurance plan, it might reimburse 50-80% of the session cost once you’ve met your out-of-network deductible. Your deductible is the amount you need to pay out-of-pocket before your insurance starts covering a percentage of the costs.

To check your out-of-network benefits, call the number on the back of your insurance card and ask these questions:

1. Do I have out-of-network benefits for outpatient mental health care?
2. What is my out-of-network deductible for outpatient mental health visits?
   • How much of my deductible has already been met this year?
3. What is my out-of-network coinsurance for mental health?
   • Coinsurance is the percentage of the service cost you pay after meeting your deductible.
4. Do I need a referral from an in-network provider or my primary care physician to use out-of-network benefits?
5. What is the reimbursement rate for these services? (Provide the representative with these CPT codes for reference):
   • 90791: New patient evaluation
   • 90834: 45-minute psychotherapy session
   • 90837: 60-minute psychotherapy session
   • 90847: Family therapy with the patient present
   • 90846: Family therapy without the patient present
6. Do I have coverage for telehealth appointments?
7. How do I submit claims for out-of-network reimbursement?

Special Cases for In-Network Exceptions
If your insurance plan doesn’t include out-of-network benefits but doesn’t have any in-network providers who can meet your specific needs (e.g., treating young children under 5), your insurance might still reimburse for out-of-network care. Call your insurance company to ask if this applies to you.