INSURANCE and out-of-network benefits: Asking your insurance plan these questions could save you $
- Gregory Sayer
- Feb 22, 2022
- 2 min read
Updated: Mar 19
If you've chosen to work with a clinician who is not in-network with your insurance provider, you will be responsible for treatment costs upfront (private pay). Ficus Psych operates as an out-of-network practice, which means that while you do pay for services at the time of your appointment, there are still options available to potentially recoup some of those costs through your insurance.
Getting Reimbursed for Out-of-Network Services
Q: Is there a way to get some money back from my insurance?
A: Sometimes!
Understanding Your Out-of-Network Benefits
Whether you can receive reimbursement from your insurance largely depends on whether your health insurance plan includes out-of-network benefits. If your plan does not offer these benefits, it is unlikely that your insurance will assist you in recouping any treatment costs. If you do have out-of-network benefits, it’s essential to familiarize yourself with the specifics of your insurance plan. Here are some key questions to look up in your policy or call your insurance company and ask:
What is the out-of-network deductible?
What percentage of costs does the insurance cover once the deductible is met?
What is the usual allowed amount for each procedure code?
Procedure Codes for Mental Health Services
When discussing your treatment with your insurance, you may need to provide specific procedure codes. Here are some of the common codes used at Ficus Psych:
Initial psychiatric evaluation: 90792
Follow-up sessions: 99213 + 90836 or 99213 + 90833
Initial evaluation by a psychologist or therapist: 90791
Follow-up sessions by a psychologist or therapist: 90837 or 90834
Medical Receipt (Superbill) for Insurance Reimbursement
To utilize your out-of-network benefits, insurance typically requires documentation from the provider detailing the services rendered. At Ficus Psych, we provide our patients with a document often referred to as a "superbill" or a medical receipt. This document can be submitted to your insurance plan.
Example Scenario: Understanding Reimbursement
For example, let’s consider Jessica, who has out-of-network benefits. Her out-of-network deductible is set at $1,000. Once she has spent this amount on eligible out-of-network care, her co-insurance will begin to apply. Depending on her specific insurance plan, she could receive reimbursement of 30% to 70% or more of the insurance plan's allowed amount for her treatments.
Stay Informed About Your Insurance Benefits
It’s important to note that insurance plan policies can change over time and often reset annually on January 1st. Therefore, it is advisable to verify your benefits periodically to ensure you are up to date with your coverage options.
For more information about our services, feel free to contact Ficus Psych today.
***Disclaimer
The content provided in this blog post is intended for informational purposes only and should not be considered medical, psychiatric, or financial advice. It is not a substitute for professional evaluation, diagnosis, opinion, or treatment. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding a medical condition or mental health issue. Please do not disregard professional medical advice or delay in seeking it because of something you have read in this blog.
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