Navigating Therapy Using Your Out-of-Network Benefits
When exploring options for starting therapy, many people naturally lean toward using their insurance benefits. While that may initially seem like the most straightforward and cost-effective route, there are numerous advantages to considering out-of-network therapy. Let’s break down some of these benefits and how you can make the most of them!
The Benefits of Out-of-Network Therapy
Choosing an out-of-network therapist can offer:
Greater choice: You have the freedom to select a provider who truly fits your needs, rather than being limited to those within an insurance network.
Fewer restrictions: Insurance often imposes limitations on the type, length, and frequency of sessions. With out-of-network therapy, these restrictions are typically not a concern.
Enhanced privacy: Insurance companies often require detailed information about your mental health treatment. Out-of-network care can offer greater confidentiality.
How to Access Your Out-of-Network Benefits
Many insurance plans provide partial reimbursement for out-of-network therapy. Here’s a step-by-step guide to help you navigate the process and get the most out of your benefits:
1. Confirm Your Benefits
Call the member services number on the back of your insurance card.
Let the representative know you’re seeking information about out-of-network benefits for outpatient mental health.
If they request a medical billing code, provide 90837 for a 60-minute individual therapy session or 90847 for a family/couples session.
Ask the representative about your coverage details, including your out-of-pocket costs and what they will cover after reaching your deductible or out-of-pocket maximum.
Don’t forget to ask about their preferred claim submission method (online portal, mail, or fax) and document the conversation for future reference.
Many insurance companies also offer member portals where you can review your plan’s benefits.
2. Obtain a Superbill from Your Therapist
A superbill is a detailed receipt that includes:
Your provider’s name, credentials, contact information
Tax ID and provider identification number
Dates of sessions, diagnosis codes, and billing codes
At Autonomy Therapy, superbills are automatically generated in our secure client portal at the end of each month.
3. Submit the Superbill to Your Insurance Provider
Complete your insurance company’s claim form, which is usually available on their website.
Submit the superbill along with the claim form through your insurer’s preferred method (online portal, mail, or fax).
4. Track Your Claim
Processing times typically range around 30 days but can take longer.
Keep copies of all submissions and follow up if you encounter delays.
5. Review the Processed Claim
You’ll receive an Explanation of Benefits (EOB) once your claim has been processed.
If approved, the reimbursement may go toward your out-of-pocket maximum, or if that’s already met, you’ll receive direct reimbursement.
If denied, review the EOB to identify any missing information and consider filing an appeal if necessary.
Need Help Submitting Claims?
Not interested in handling the process yourself? Consider using Reimbursify, a service that handles claim submissions from start to finish. Even better — your first claim submission with them is free!
Ready to Get Started?
If you’re interested in working with one of our dedicated therapists, we’d love to connect. Fill out our contact form or use our booking page to schedule a free 15-minute consultation call. Our knowledgeable admin team is here to answer your questions and support you through the process of accessing out-of-network care.
Your mental health is an investment, and we’re here to help you make the most informed and empowering choice for your care.
