Anthem / Blue Cross Blue Shield

Paramount

Medical Mutual

Aetna

Cigna

Frontpath

United Health Care UHC / UMR / Optum

Carelon / Beacon 

Caresource

Tricare / Humana (OON only)

M & S EAP

ESI EAP

Health Advocate EAP

 

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Out of Network (OON) Insurance Benefits

 

When inquiring about out-of-network mental health benefits with your health insurance company, it's important to communicate clearly and gather all the necessary information. Here's a step-by-step guide on how to do so:

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1. Gather Information: Before reaching out to your health insurance company, gather all relevant information about your current policy. This includes your policy number, the name of the insurance company, and any documentation you may have received when you enrolled.

2. Contact Customer Service: Call the customer service number provided by your health insurance company. This information is usually found on your insurance card, the company's website, or any communication you've received from them.

3. Be Prepared to Identify Yourself: When you call, you'll likely be asked to verify your identity for security purposes. Have your policy number, date of birth, and other identifying information ready.

4. State Your Purpose Clearly: Explain that you're calling to inquire about the out-of-network mental health benefits available under your policy. You might say something like: "I'm calling to understand the out-of-network mental health benefits included in my policy."

5. Ask Specific Questions: Make sure to ask specific questions to gather the information you need. Here are some questions you might consider asking:

   • Can you explain the coverage details for out-of-network mental health services?

   • What percentage of the cost will be covered by the insurance for out-of-network mental health visits?

   • Is there a deductible or out-of-pocket maximum that applies to out-of-network mental health services?

   • Do I need to get pre-authorization or submit any documentation before seeking out-of-network mental health care?

   • Are there any limitations on the number of sessions or types of therapy covered?

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

   • What is my out-of-network deductible for outpatient mental health? (Outpatient means treatment outside a hospital.)

   • What is my out-of-network coinsurance for outpatient mental health?

   • Do I need a referral from an in-network provider to see someone out-of-network?

   • How do I submit claim forms for reimbursement? (Claims are forms that are sent to your insurance company to receive reimbursement for sessions you paid for out of pocket.)

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Not all insurance companies offer out of network benefits and not all out of network benefits cover mental health therapy, but it’s worth an ask to your insurance. 

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Depending on your insurance, we may either send you a superbill or send the claim to your insurance for reimbursement. In some cases, we will need to charge you the full rate, and your insurance will reimburse you typically via check in the mail. 

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Please do not hesitate to ask us additional questions regarding your out of network benefits.