5 Quick Questions to Ask [when calling about your out-of-network benefits]

5 Quick Questions to Ask [when calling about your out-of-network benefits].jpg

Orlando Counseling Providing Therapy Resources

You’ve finally decided that you’ve had enough. You’re tired of feeling this way. You’re ready to reach out for some help. Here at Mindful Living Counseling Services, we understand.

First of all, I want to to acknowledge how difficult this has been. People don’t reach out to a therapist when things are going great. People go through lot of pain and discomfort before actually deciding to call a counselor.

For folks that want to use their out-of-network insurance benefits for counseling services, there is the tedious task of trying to figure out how it all works. I’ve written this post to provide you an easy script when calling your insurance company in order to make using your out-of-network benefits simple and clear during an already difficult time.

As an anxiety and trauma therapist providing counseling in Orlando, I feel it is important to provide potential clients with an easy peasy guide to using your out-of-network benefits for counseling. I’ve provided a list of 5 questions to ask when calling your insurance company about using your out of network benefits for counseling.

  1. What is my out-of-network deductible?

    This will let you know how much money you need to spend out-of-network before your benefits will kick in. I have seen plans have deductibles as low as $500 and as high as $3,000.

  2. How much of my out-of-network deductible has already been met?

    Finding out how much you’ve already spent will let you know how much more you need to spend in order to meet your out-of-network deductible. For example, if your out-of-network deductible is $1,000 and you’ve already spent $850, you will only need to spend $150 more before your out-of-network benefits kick in.

  3. What is my policy period?

    A “calendar year” policy starts on January 1 and ends on December 31. A “policy year” policy is a 12 month policy that will have a different start and end date, for example, August 1-July 31. It is important to determine your policy period when factoring in how much more time you have to meet your deductible.

  4. What is my coinsurance?

    This is the percentage amount that your insurance company will reimburse you for each visit (after your out-of-network deductible is met). Let’s say your therapy visits are $130 per session and you have a 60% coinsurance. After reimbursement, you will only come out of pocket $52 per visit.

  5. How do I submit for reimbursement?

    Typically, you will need to obtain a Superbill from your therapist and submit it to your insurance company. A Superbill is a document your therapist will provide to you that will include dates of service, a diagnosis code, a CPT code, and your therapist’s NPI and EIN numbers. Insurance companies have different ways to submit the Superbill, typically through snail mail or fax.

  6. How long do I have to submit my Suberbill?

    Ok, so this a bonus question. I realized after I published this blog post, this is an important question to ask, too. There is a time period after the “date of service” to submit the Superbill to your insurance company for reimbursement. So far, I’ve seen this range from 90-180 days. Make sure you find out how much time you have to submit the Superbill after “the date of service” when calling your insurance company.

All insurance plans are different. Have this list of questions handy when calling your insurance company to determine the specifics about your plan.

Please feel free to leave comments or feedback in the comments section below!

Lauran is an anxiety and trauma therapist providing counseling in Orlando, FL. She also specializes in helping people heal old broken relationship patterns that keep them from finding, creating, and keeping healthy relationships with partners, friends, and family. Lauran uses a down to earth approach infused with cutting-edge therapies that go beyond traditional talking to help clients feel calm in their body and mind and find peace within themselves.