How to Use Your
Out-of-Network (or PPO) Benefits:
I work with all insurances as an out-of-network provider: you pay for your sessions out of pocket and your insurance partially reimburses you 50-80%.
Call the number on your insurance card and ask the representative if you have OON benefits. Inform them that you will be receiving professional visits for mental health, and provide the CPT codes 90791 (first session) and 90834 (all other sessions) to see how much they will cover.
Claims: I will send you an invoice or superbill with the billable clinical diagnoses (like F41.1 for Generalized Anxiety), which makes your sessions "medically necessary" and acceptable to your insurance company. The superbill will be sent to your email address as an attachment that you can upload to your insurance provider. You are responsible for submitting claims for your visits to your insurance provider with the monthly superbill that I will provide.
Deductibles: Some out of network coverage will have its own deductible, which means that only visits to out of network doctors/professionals will apply to this amount and you must reach it before your insurance company starts to help cover some of the cost. Luckily, some deductibes can be as low as $100. Once you’ve met your deductible (if you have one), your insurance company will reimburse you for a percentage of your costs. They send the payments directly to you, since you’ve been paying for your sessions out of pocket.