Out of Network Guide

• Set aside time for a 15-20 minute call, or browse your provider’s website
• Have your insurance card and ID ready
• Ask if you have out-of-network benefits, then more specifically:
  • Does that include mental/behavioral health out-of-network?
  • Is prior authorization required?
  • Is a referral required from my primary care physician?
  • Do I have an out-of-network deductible?
    • If no, skip to next question
    • If yes, ask:
      • 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?
  • Does my policy cover a diagnostic interview (CPT code 90791) and individual therapy for up to 50 minutes (CPT code 90834)?
• What percentage of the session fee (e.g. $150) do they cover and how much will you be reimbursed?
• What is the claim submission process like? What paperwork will you need?