What Are Out-Of-Network Benefits And How Can I Use Them to Pay For Therapy?
What are out-of-network benefits?
Out-of-network (OON) benefits are a type of benefit that allow you to get reimbursed for health or mental health services with a provider who is not credentialed (in-network, or INN) with your insurance plan. They are most often found in PPO plans.
How do they work?
Normally, if you see a healthcare provider, they charge you a copay or coinsurance at the time of your appointment and will bill the rest of the fee for their services directly to your insurance, who will then reimburse them if the claim is approved. With OON benefits, however, the provider charges you their whole fee upfront and then provides you with a Superbill, which you can then submit to your insurance along with a claim. Your insurance will then reimburse you some or all of the cost, provided your claim is approved.
How do I know if I have OON benefits?
You can contact your insurance’s benefits center to find out whether or not your plan includes OON benefits. You should be able to find their phone number on the back of your insurance card. If you plan to use OON benefits to see a therapist or mental health provider, you can ask them whether “mental health” or “behavioral health” services are covered. They will also tell you how much you will be reimbursed for each appointment. Other helpful questions to ask may include “Is there a maximum number of sessions that I will be reimbursed for?” and “How much is my deductible, and does it need to be met before I can start getting reimbursed?”.
What if I don’t have the time or energy to submit a Superbill each month?
Totally understandable. At Evoluer Counseling, we partner with Mentaya to make submitting OON claims easy and risk free. They charge a 5% fee to file the claim, and will deal with denials and resubmissions if necessary, saving you the headache. If your claim is ultimately denied, they will refund you the 5% fee. Click here to check your benefits and see if you’re eligible for reimbursement.
Why would I see an OON provider when I could just see an INN provider who bills directly to my insurance?
The biggest benefit to expanding your search to OON providers is that you have more options, making it more likely that you find the right therapist for you. Many specialty therapists are only credentialed with a limited number of insurance companies (if at all), making it difficult to find someone who can truly provide the best treatment for the issue you’re dealing with. Using OON benefits can make seeing a specialist more affordable.
We know navigating insurance can be stressful and overwhelming, no matter what type of benefits you’re looking to use! We’re here to help make the process as seamless as possible. If you’ve been searching for a therapist who specializes in OCD, PTSD, or anxiety and want to know more about your options for payment, click here to contact us. We look forward to helping you get started on your path towards healing.
