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?