Out-Of-Network Benefits
How to check your out-of-network coverage and possible out-of-network benefits:
Plan for 15-30 minutes of your time available to call your insurance company
Make sure to have this information ready before your call:
Insurance card
Name, date of birth, address, phone number, or possibly social security number of the cardholder or person for whom the services are for
Pen and paper/notepad
Questions to ask:
Are there out-of-network benefits for this policy?
Do I have a mental or behavioral health policy with out-of-network benefits?
What are the requirements to use out-of-network benefits?
Is prior authorization required?
Is a referral required from my primary care physician?
Do I have an out-of-network deductible?
If yes:
What is my out-of-network deductible?
How much of my out-of-network deductible has been met?
What is the start date of the calendar year my out-of-network policy is based on?
In addition, ask the representative if your policy covers couples therapy, CPT code 90847. How much is the insurance company’s “usual and customary fee” and what percentage do they cover?