How to communicate with your insurance
understanding your out-of-network benefits
Be Prepared
Have pen and paper nearby and before calling, jot down some information that will likely be needed:
Your member ID
Your date of birth
Your provider’s licensure (in order to get accurate information, you will likely need to offer this information as reimbursement rates can vary by licensure type). Jacquie is a Licensed Mental Health Clinician.
Procedure codes (reimbursement rates may vary with different codes)
Connect with an agent: Follow the phone tree prompts, choosing “benefits” and seeking a live agent.
Ask About Out-of-Network Benefits:
Clarify what your out of network benefits are for outpatient psychotherapy services. Be sure to ask what your deductible versus copayment may be.
If you are informed that you will be reimbursed a percentage, follow up and ask what the “allowable rate” is for this service (For example, your insurance plan may cover 50% of a session, but anything beyond the allowable rate will be your responsibility). Ask for the reimbursement rate for an intake session (procedure code 90791) and a 50 minute therapy session (procedure code 90837).
How to submit for reimbursement
Each insurance company may offer different ways for individuals to submit for reimbursement. Do you send something via email? Or is there an online submission form? Ask how long you have to submit, and what needs to be included on the invoice.
