How to Get Insurance Reimbursement for

“Out-of-Network” Providers

We’ve prepared this document to make it easy for you to get insurance reimbursement for our services. If you have any questions, please email info@relationshipswork.com or call Lori at 410-868-2039.

What are “Out-of-Network” Providers?

“Out-of-network” providers are doctors and other professionals who are independent of insurance companies, i.e. they do not “participate” with the insurance company’s network.

Most insurance policies (except for HMOs) will provide you (the “patient”) with reimbursement for a portion of the fee, when you see a provider outside their network.

How does it work?

You pay the provider their full fee. (Our fee is $160 per session.) The provider gives you a “Superbill” that you submit to the insurance company. They, in turn, will reimburse you for a portion of the fee. The amount of reimbursement depends upon your individual policy benefits.

How do I find out the amount of reimbursement I will get?

Call the 800# for mental health or member services on the back of your insurance card. (You may also find this information on-line or in your employee handbook.)

WHAT TO ASK:

1) Does my policy provide “Out-of-Network” benefits for Mental Health?

2) Do I have a deductible for “Out-of-Network” providers? If so, what is that amount?

3) What is the amount I will get reimbursed for psychotherapy?

Tell them:

  • The procedure code is: CPT 90837 GT - 60-minute Psychotherapy Tele-Therapy Session

  • The Provider is an LCSW-C (Licensed Certified Social Worker-Clinical).

They will likely give you a percentage.

  • For example, they may cover 80% of the “usual and customary rate, recognized rate or allowable rate.”

Tell them the amount of the provider’s full fee (for us, $160 per session) and ask if that amount is within their "allowable rate.”

  • If they say yes, you will get reimbursed 80% of the provider’s full fee. For example, 80% of $160, or $128.

  • If they say no, ask what is the “allowable rate.”? They may say, for example, $110. This means you will get reimbursed 80% of $110, or $88.

4) Lastly, ask them how and where you submit a“Superbill” to get reimbursed.

That’s it! Please call or email me if you have any questions.