Understanding Out-of-Network Benefits

If your insurer allows electronic claims, I will submit the claim on your behalf. If your insurer does not allow electronic claims for patient reimbursement, then I will provide you with the documentation you need to submit the claim yourself.

My practice, like many psychiatric practices, is “out-of-network” for most insurance companies. This does not mean that you will bear 100% of the cost of your appointments. It simply means that your visits will be covered by your insurance company at a different rate, usually slightly lower than the in-network rate. It also means that I will collect the full cost of the appointment up front, and will direct your insurer to send reimbursement to you.

Different insurers handle out-of-network benefits differently. I encourage you to contact your insurer to verify your out-of-network benefits. Questions to ask:

  • What are my out-of-network benefits?
  • What percentage of my out-of-network visits are covered after I meet my deductible?
  • What is the allowed rate for a 99204 (initial visit)? For the dual codes of 99213 plus 90836 (medication plus therapy)?
  • Do my out-of-network visits have a different deductible than my in-network visits?

Please don’t hesitate to bring up your concerns so that we can work together to make high-quality treatment affordable and accessible.