Call the member services number on the back of your insurance card and ask whether your plan includes out-of-network benefits for outpatient mental health or behavioral health services.

If you do have coverage, the questions below can help you understand how your benefits work.

When speaking with your insurance provider, consider asking:

• Do I have out-of-network benefits for outpatient behavioral health services?

• Do I have an out-of-network deductible? If so, how much is it?

• How much of my deductible have I already met?

• Once my deductible is met, what percentage of out-of-network therapy costs will my plan reimburse?

• What is the allowed amount or usual and customary rate for a 45-minute psychotherapy session?

• Is there a limit on the number of therapy sessions covered each year?

• Do I need prior authorization or a referral?

• Are telehealth sessions eligible for out-of-network reimbursement?

• How do I submit a claim for reimbursement?

• What documentation will I need from my therapist?

It can be helpful to take notes during the call and ask for a reference number for the conversation in case you need to follow up later.

Your deductible is the amount you are responsible for paying before your insurance company begins reimbursing you for eligible out-of-network services.

For example, if your plan has a $1,500 out-of-network deductible, you may need to pay $1,500 toward eligible out-of-network healthcare expenses before your reimbursement benefits begin.

Ask your insurance company both what your deductible is and how much of it you have already met for the year.

This is an important question to clarify with your insurance company.

A plan that says it reimburses 70% for out-of-network therapy does not necessarily mean it will reimburse 70% of your therapist's fee. Insurance companies may calculate reimbursement based on their own “allowed amount” or “usual and customary rate.”

Ask your insurance representative:

“Once my deductible is met, what would my estimated reimbursement be for a 45-minute out-of-network psychotherapy session?”

This can give you a more useful estimate of your actual out-of-pocket cost.

This is the amount your insurance company considers eligible for reimbursement for a particular service. It may be different from your therapist's actual fee.

Because reimbursement policies vary by plan, asking about the allowed amount for the specific service can give you a clearer picture of what your insurance may reimburse.

A superbill is a detailed receipt that includes the information your insurance company may need to process an out-of-network claim.

We can provide the superbill (also called a “Statement for Insurance Reimbursement”) for you to submit to your insurance company for possible reimbursement.

Each insurance company has its own process. Many plans allow members to submit out-of-network claims through their online member portal or mobile app.

Ask your insurance provider:

“How do I submit an out-of-network mental health claim, and what documentation do you require?”

Your insurer can walk you through its specific submission process.

Out-of-network coverage and reimbursement are determined by your individual insurance plan, and benefits can vary considerably. We do not guarantee that your insurance will reimburse you.

However, we encourage you to confirm your benefits directly with your insurance provider before beginning treatment. Our team can provide the documentation needed for claims and guidance to make the process easier to navigate.

Insurance terminology can be complicated. Our guide can help you better understand your out-of-network benefits and what to ask your insurance provider. Our team is available to guide you through the process and provide the documentation needed to submit claims for reimbursement.