Help Navigating Out-of-Network Insurance Reimbursement

Out-of-network reimbursement is a great way to offset the cost of therapy, but navigating insurance is often confusing and challenging.  If you plan to use out-of-network insurance benefits, I highly recommend that you call your insurance company to get additional information before starting therapy. This will help you determine how much of the cost you will incur yourself.  

Call your insurance provider at the number listed on the back of your insurance card and ask the following questions to get started:

  • What are your mental health benefits (sometimes also called "behavioral health" benefits)? 

  • What is the amount of your deductible (the amount of money you have to pay before your insurance company will start to reimburse you) for out-of-network benefits? Have you already paid any of this deductible? 

  • Do you need any kind of pre-authorization or special referral (e.g. from a primary care doctor or your university counseling center)? If yes, what is the process for obtaining this?  

  • How much of each therapy session will your insurance provider reimburse (usually given in a percentage) for the following CPT/procedure codes: initial appointment - 90791, individual therapy - 90837, and both of these codes with modifier POS 2 (telehealth)? Is there a “maximum allowed amount” for these CPT codes  (also known as a “reasonable and customary fee”) for zip code 30318 for a licensed psychologist (PhD)?

  • Are there any limitations to services (e.g., a cap on how much can be spent, number of sessions, reimbursements for only certain diagnoses, etc.)?