Out of Network Insurance Coverage
In order to determine how much your insurance will contribute to the cost of therapy, the answers to the following questions are necessary. Please call member services and ask the following:
- What is my out of network deductible?
- After I meet your deductible, what is the reimbursement amount for the following CPT code (procedure code) for an out of network provider?
90834 for individual therapy
90847 for couples therapy
- To clarify, ask them how much you would be reimbursed for paying $300 for the service. If they cannot give you that amount, ask if it is based on a “usual and customary” rate or based on the actual amount charged.
- Is the reimbursement amount different for CPT code modifier 95? (This is asking if the reimbursement amount is different for teletherapy vs. in-person therapy).
- What is my out of pocket maximum is for out of network coverage? Does this include my deductible or is this in addition to my deductible?
- Is my deductible year a calendar year (meaning it resets in January) or another month?
- How long do you have to submit your claims?