How do I find out if I have Out-of-Network benefits?

 

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Call the customer service number listed on the back of your insurance card.

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Here are some questions you may want to ask:​

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• Do I have out-of-network behavioral health benefits?

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• If yes, is procedural code (aka CPT code) 90837 {60-minute psychotherapy session} with Modifier GT {therapy done online through telehealth} covered? 

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• If yes, are telehealth visits covered {place of service #10}?

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• Do I have an out-of-network deductible?

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• If yes, is this deductible combined with my in-network deductible, or is it separate?

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• How much of this deductible has been met this year?

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• Do I have a co-insurance for out-of-network services once my deductible has been met?

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• What is the "allowed amount" for CPT code 90837 {or, in other words, how much of the $160 session fee will be reimbursed}?

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• My therapist will give me a "Superbill" receipt each month. What is the reimbursement process for out-of-network claims {or, in other words, how do I submit my receipt for reimbursement? This is usually down by simply uploading the receipt to your patient portal.} 

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• Is any pre-approval required before obtaining out-of-network outpatient behavioral health services?  {This answer is almost always "no".}