There are important questions to ask your insurance provider when you have a PPO plan and want to be reimbursed for out-of-network mental health services:

1.       Do I have out-of-network mental health/therapy benefits?

2.       Is there a deductible I must meet before reimbursement begins? If so, how much is it?

3.       What percentage of the fee is reimbursed once the deductible is met?

4.       Is there a maximum allowable amount for reimbursement?

5.       Are telehealth (video or phone) therapy sessions covered out-of-network?

6.       How do I submit claims (superbill)? Can it be done online or only by mail/fax?

7.       Is there a deadline to submit claims after the date of service?

8.       How long does it typically take to receive reimbursement?

9.       Are there any limitations on the number of sessions per year?

10.  Is pre-authorization required for any mental health services?

11.  Are there diagnoses that are not covered for reimbursement?

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Terms

Out-of-Network: A provider or service not contracted with your insurance; you may pay more and need to file claims for reimbursement.

Deductible: The amount you must pay out-of-pocket for services before your insurance starts to reimburse you.

Co-insurance: The percentage of costs you pay after meeting your deductible; your insurance covers the rest.

Copay: A fixed amount you pay out of pocket for a covered healthcare service, due at the time of your appointment.

Superbill: A detailed receipt from your provider that includes all necessary information to submit a claim for reimbursement.

Preauthorization: Approval from your insurance company that a service is medically necessary before you receive it.

Reimbursement: Money your insurance pays you back after you’ve paid out-of-pocket for covered services.