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?
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Philadelphia, PA 19107
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