Questions to Ask Your Insurance Company About
Out-of-Network Benefits
If you’re considering working with an out-of-network therapist, it can be helpful to call your insurance company and ask the following questions to understand your coverage and costs:
Do I have out-of-network mental health benefits?
If yes, ask what percentage of the session fee is reimbursed.
Is there a deductible I need to meet before out-of-network benefits begin?
If so, how much is it, and how much have I met so far?
What is the “allowed amount” or “maximum reimbursable amount” for out-of-network therapy sessions?
(This helps you understand what portion of the fee your insurance uses to calculate reimbursement.)
Do I need pre-authorization or a referral from my primary care provider to see an out-of-network therapist?
Are there any limits on the number of therapy sessions per year?
Do you cover telehealth (online therapy) sessions the same way you cover in-person sessions?
How do I submit a claim for reimbursement?
What documentation do I need? (e.g., a superbill from my therapist)
How long does it typically take to receive reimbursement once I submit a claim?
What address or online portal should I use to submit claims?
Are there any diagnosis or treatment codes required for reimbursement?
(Your therapist can include these on your superbill if needed.)
Tip: When you call, write down the name of the representative, the date, and what they told you — it’s helpful to have that record when submitting claims.
Some insurance companies have a “chat” feature, which allows you to download the entire “chat” after the conversation, so you can easily have everything in writing.