Inquiring About Out-of-Network (OON) Benefits

Please see the script, below, to use when calling your insurance company to check benefits.

OON Benefits Inquiry Script

“Hello, I’m calling to ask about my out-of-network mental health benefits for outpatient psychotherapy.”

• Is [Your Plan Name] a PPO or HMO?

• Do I have out-of-network benefits for outpatient mental health treatment?

• What is my deductible for out-of-network care?

• How much of my deductible has been met this year?

• After I meet the deductible, what percentage of each session is reimbursed?

• Is there a maximum number of sessions covered per year?

• Are there any forms I need to submit along with a superbill from my psychologist?

• What is the process for submitting claims? Online or by mail?

• How long does it typically take to receive reimbursement?

“Thank you for your help. I’m working with a psychologist who will be out-of-network, and I want to make sure I understand what coverage I might have.”

Please contact us if you have questions about OON benefits.

OUT-OF-NETWORK SUPERBILLS AND CLAIMS SUBMISSION GUIDE

Your clinician can provide you with a superbill, which is a detailed receipt that includes required information. You can then submit this to your insurance company for possible reimbursement to you.

What’s on Your Superbill:

• Date of session

• CPT code (procedure code)

• Diagnosis code (ICD-10)

• Clinician name, national provider Identifier (NPI), license, and address

• Session fee and amount paid

Steps to Submit a Claim:

1. Log into your insurance provider’s member portal or call their benefits department.

2. Look for a Claim Submission Form for out-of-network mental health services.

3. Attach your superbill (or upload it digitally).

4. Submit by the method your insurer requires (mail, online, or fax).

5. Track your claim for reimbursement status.

If you need help, bring your form or portal instructions to session and your provider will walk you through it.