The following steps can help determine if your out-of-network benefits will cover some of the cost of treatment:
1. Call your insurance carrier to see if your policy provides mental health benefits out-of-network, meaning with providers not enrolled in your plan. While reviewing your out-of-network benefits, it is helpful to also find out what deductible must be met, or what you must pay before you are eligible for reimbursement.
Note: Many insurance companies determine what they call an acceptable or allowable amount which caps the session fee that they will cover regardless of what is billed by your provider. This can impact both meeting the out-of-network deductible and the amount you will be responsible for paying after your deductible has been met.
The best way to be absolutely sure of your benefits is to clarify with your insurance company member services line. You can find this phone number on the back of your insurance card. Ask these questions when speaking to your insurance company about benefits:
- How much of my deductible has been met this year?
- What is my out-of-network deductible for outpatient mental health? (Outpatient means treatment outside a hospital.)
- What is my out-of-network coinsurance for outpatient mental health?
- Do I need a referral from an in-network provider to see someone out-of-network?
- How do I submit claim forms for reimbursement? (Claims are forms that are sent to your insurance company to receive reimbursement for sessions you paid for out of pocket.)
MBHA will provide you with a Superbill that you can send to your insurance company for reimbursement. The Superbill details all the necessary codes and information to properly submit your claim.