INSURANCE and out-of-network benefits: Asking your insurance plan these questions could save you $

Updated: Sep 17

If you've opted to work with a clinician who is not in-network with your insurance, you will be responsible for treatment costs up front (private pay). Sage Minds is an out-of-network practice.


Q: But is there a way to get some money back from insurance?

A: Sometimes!


It depends on whether or not you have out-of-network benefits as part of your health insurance plan. If you do not, then it's unlikely your insurance will be able to help you recoup some of the cost.


If you do have out-of-network benefits, look up or ask your insurance plan about the details.

Asking what the out-of-network deductible is, percentage insurance pays once deductible is hit, and an estimate of what the usual allowed amount is for each procedure code can give you a sense of how much you might get back.


If they ask, the procedure code for a psychiatric initial evaluation is typically 90792 while follow ups are typically 99213 + 90836 or 99213 + 90833.

Procedure code for an initial evaluation by a psychologist or therapist is typically 90791 while follow ups are typically 90834.


For example, let's say Jessica has out-of-network benefits and her out-of-network deducible is $1000. Once she has spent $1000 on eligible out-of-network care, her out-of-network co-insurance contributions would kick in. Insurance would then remit a percentage of treatment costs back to Jessica. Depending on her plan, she could get 30-70% of the insurance plan's allowed amount paid back to her from insurance.


Insurance requires a document from the provider detailing these services to utilize the out-of-network benefits. Sage Minds provides those to patients and are often called a "superbill" or a medical receipt.




#tips #finances #insurance

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