what are out-of-network (OON) benefits, and can i use them?

some insurance companies and policies allow folx to access out-of-network providers. this means, even if a provider is not paneled with/does not accept your insurance, you can still be reimbursed for services. you would pay full fee at time of service, and i would provide you with a superbill to submit to your insurance for reimbursement. clients are responsible for obtaining reimbursement. here are some questions you can ask your insurance rep to help clarify your benefits:

• does my health insurance plan include mental health benefits?

• do i have out-of-network benefits for mental health coverage?

  • if so, what percentage is covered?

• what is the co-pay for a session if i see an out-of-network provider?

• do i have a deductible? what is it and how much of it have i met?

• how do i submit a request for OON reimbursement?

• what is the reimbursement for CPT code 90834?

• does my plan limit how many sessions per calendar year i can have?

  • if so, what is the limit?

• do i need written approval from my primary care physician in order for services to be covered?