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?