What is out-of-network coverage?

Step 1. Find out what your out-of-network coverage is

  • Take a look at your insurance card. If your card states PPO or POS, call the number on the back. If you see several numbers to call and one of them says “BH”, that stands for “Behavioral Health” so we’d recommend starting with that phone number. Be ready to read out some of the numbers on the front of the card. If your card says HMO, you likely do not have out-of-network benefits.

  • Ask the following questions:

    • “Do I have out-of-network coverage for behavioral health?” This question will tell you whether or not out-of-network therapy is covered by your insurance plan.

    • “What deductible do I need to meet before you will start reimbursing?” This will tell you how much you need to pay out of pocket before they will start paying you back for some of the session cost. Deductibles vary. It is helpful to know your deductible because they will start paying you back once you reach that mark.

    • "What percent do you cover?” It could be more or less, but the answer is often 50-80% of what they call “allowable” reimbursement. Every insurance company has this secret number of what they will cover.

Step 2. Download Reimbursify

  • Download the Reimbursify app here.

    • The Reimbursify app helps to make things as easy as possible for you (they do charge $2.99 a claim), but you can always contact your insurance company to learn their unique process to submit an out-of-network claim.

Step 3. Ask your therapist for a “superbill”

  • You will then receive a document called a “superbill” every month. This is a special kind of invoice that lists specific information on the type of service you received, by which clinician, and with what diagnosis. You can’t be covered by insurance without a diagnosis that they are willing to cover for. Your therapist can talk to you privately about what diagnosis would fit your experience. Your therapist will need to know you are wanting a superbill so they can make sure the copies you get have all the correct info it needs on it.

Step 4. Upload your superbill to Reimbursify.

  • Reimbursify will make everything super easy for you. Once you upload a superbill for the first time (it takes about 2-5 minutes), you’re set.

  • After submitting for the first time, you can just click “clone” or duplicate and it’ll cut your submission time down to about 30 seconds.

NO MORE STEPS!

  • Once you hit your deductible, your insurance company will start mailing reimbursement checks to your mailing address.