How do I find out if I have Out-of-Network benefits?

 

Call the customer service number listed on the back of your insurance card.  Here are some questions you may want to ask:

 

1. Do I have out-of-network behavioral health benefits?

2. If yes to #1 is Procedural Code 90837  (60-min psychotherapy session) with Modifier 95 or Modifier GT (therapy done online through tele-health) covered?   

 

3. If yes, is the telehealth standard for out-of-network behavioral health coverage, or just during Covid-19 response dates?

4. Do I have an out-of-network deductible?

5. If yes to question #4, is this deductible combined with my in-network deductible, or is it separate? How much of this deductible has been met this year?

6. Do I have a co-insurance for out-of-network services once my deductible has been met?

7. Is any pre-approval required before obtaining out-of-network outpatient behavioral health services? 

8. Is there a maximum number of sessions I am covered per year?

9. My therapist will give me a "Superbill" receipt each month.  What is the reimbursement process for out-of-network claims? 

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