Out of Network Reimbursements
It’s important to educate folks on how to advocate for their mental health care. It can be tricky when the provider you want to see who specializes in what you want to work on doesn’t panel with insurances aka a private pay provider.
As a private pay provider, I do not bill insurance directly. However, if you have out-of-network benefits, you may be able to receive partial reimbursement from your insurance company. Below is a step-by-step guide to help you through the process:
1. Check Your Out-of-Network Benefits
Start by contacting your insurance provider to ask about your out-of-network mental health benefits. You’ll want to ask the following questions:
Does my plan cover out-of-network providers for mental health services?
What percentage of costs does the plan cover for out-of-network services?
What is my out-of-network deductible, and how much of it has been met?
What is the process for submitting a claim for reimbursement?
2. Pay for Services Upfront
You will be responsible for paying the full session fee at the time of service. To help with reimbursement, your provider can provide you with a superbill (a detailed receipt).
3. Request a Superbill
After each session (or on a monthly basis, if preferred), I will provide you with a superbill that includes all the necessary information, such as:
My practice details (name, credentials, contact info, and tax ID/NPI).
Your name and the date of the session(s).
The type of service provided (CPT code).
The full fee for each session and what you paid.
A diagnosis code (if applicable).
4. Submit the Superbill to Your Insurance
You will need to submit the superbill directly to your insurance company. Some insurers allow electronic submission via their website, while others may require you to mail in the paperwork. Be sure to:
Complete any required forms.
Keep copies of everything for your records.
5. Follow Up with Your Insurance Provider
After submitting your claim, it’s a good idea to follow up with your insurance provider to check on the status of your reimbursement. Sometimes additional information is needed to process the claim.
6. Receive Reimbursement
If approved, your insurance company will send the reimbursement directly to you. The amount reimbursed will depend on your insurance plan’s terms, such as the out-of-network coverage percentage and deductible.
Please remember that reimbursement is not guaranteed and will depend on your specific insurance policy. If you have questions about this process or need further assistance, feel free to reach out. You can also contact your insurance company or a billing specialist for additional support.