What is out-of-network coverage?
Insurance can be so confusing. We want to help you take the mystery out of it so you can be your most empowered.
Step 1
Find out what your out-of-network coverage is.
Grab your insurance card. If your card states PPO or POS, call the number on the back. If you see several numbers to call and one of them says “BH”, that stands for “Behavioral Health” so we’d recommend starting with that phone number. Be ready to read out some of the numbers on the front of the card. If your card says HMO, you likely do not have out-of-network benefits.
Ask the following questions:
“Do I have out-of-network coverage for behavioral health?” This question will tell you whether or not out-of-network therapy is covered by your insurance plan.
“What deductible do I need to meet before you will start reimbursing?” This will tell you how much you need to pay out of pocket before they will start paying you back for some of the session cost. Deductibles vary widely. Some people might have a deductible of $250 where someone else will have a deductible of $8,000. Either way, this is super helpful to know because they will start paying you back once you reach that mark. Even if you weren’t originally planning to use insurance, it might still be worth working towards meeting your deductible so you can get money back when you meet that amount.
"What percent do you cover?” It could be more or less, but the answer is often 50-80% of what they call “allowable” reimbursement. Basically, every insurance company has this secret number of what they will cover. So as an example, Modern Therapy might provide a service to you for $198, but your insurance company will say, “ok, got it. Our allowable reimbursement is based off of $170. So we’ll pay you 60% of $170 and not 60% of $198.” Why? Insurance has their way of setting up their systems, so we can't answer that for you, but at the end of the day, in the above example, you’d still be getting a check for $102 back for each session. Cutting your cost for therapy sessions at MT down to $96 a session once you receive your reimbursement.
Step 2
Download Reimbursify
Download the Reimbursify app here.
We’ve found the Reimbursify app to make things as easy as possible for you (they do charge $3.99 a claim), but you can always contact your insurance company to learn their unique process to submit an out-of-network claim.
Step 3
Tell your therapist you need a “superbill”
You will then receive a document called a “superbill” every month. This is basically a special kind of invoice that lists specific information on the type of service you received, by which clinician, and with what diagnosis. You can’t be covered by insurance without a diagnosis that they are willing to cover. Your therapist can talk to you privately about what diagnosis would fit your experience. Your therapist will need to know you are wanting a superbill so they can make sure the copies you get have all the correct info it needs on it.
Step 4
Upload your superbill to Reimbursify. It takes about 2-ish minutes.
Hooray for Reimbursify! They will make everything super easy for you. Once you upload a superbill for the first time (it takes about 2-5 minutes), you’re set.
After submitting for the first time, you can just click “clone” or duplicate and it’ll cut your submission time down to about 30 seconds.
NO MORE STEPS!
You’ve now learned how to submit out-of-network benefits. Once you hit your deductible, your insurance company will start mailing reimbursement checks to your mailing address.
A FEW DETAILED THINGS TO CONSIDER: WHETHER IT’S THERAPY OR ANOTHER HEALTHCARE SPECIALIST YOU’RE SEEING, ANY OUT-OF-NETWORK HEALTHCARE YOU ENGAGE IN CONTRIBUTES TO YOUR DEDUCTIBLE. PLEASE NOTE, NOT ALL INSURANCE COMPANIES DEEM COUPLES THERAPY AS A MEDICAL NECESSITY SO THEY MAY NOT COVER THAT SERVICE. THEY SOMETIMES DO. YOU CAN FIND OUT BY ASKING ”DO YOU COVER FOR CPT CODE 90847”?
