Updated: Aug 18
If you've opted to work with a clinician who is not in-network with your insurance, you will be responsible for payment (private pay).
Q: But is there a way to get some money back from insurance?
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 out-of-network care, she may then be eligible to a percentage of future treatment reimbursed to her by her insurance company. Depending on the plan, someone could get 30-70% of the insurance plan's allowed amount back from insurance.