What Are Out of Network Insurance Benefits?

​Feature by Nikita Fernandes

Image via Pixabay

The world of health insurance can be hard to navigate when you don't know where to start. Clients of healthcare services experience difficulty when they try and figure out how health insurance works. Many people might not even be aware that they have mental health insurance benefits. When clients see therapists that are private pay, it might not strike them to use their out of network benefits. In addition to this, insurance terms like claims, deductibles, and coinsurance are confusing to people who have never used certain benefits before. It is important for consumers of services to be aware of how to navigate insurance benefits and make the best use of their mental health insurance. Out of network benefits refers to the benefits that insurance offers to clients who use providers out of their network. Thus, clients would pay for the healthcare service upfront and get mental health out of network reimbursement for the expenses they incur.

It is important to note that depending on insurance plans, not all clients out of network benefits and some clients might have to pay a certain amount out of pocket (in other words, meet their mental health out of network deductible) before their health insurance starts to cover a part of their total cost. To learn more about your mental health out of network insurance benefits, you could call the number on your insurance card and ask the following questions:

• What are my out of network benefits?
• Do I have to meet a deductible before my out-of-network benefits kick in?
• Do I need preauthorization of mental health services?
• What is my out of network out of pocket maximum?
• How do I submit a claim after I pay for my therapy session?
• What information do I need from my provider to submit the claim?

​Author

Nikita Fernandes is a mental health therapist in New York City. She is currently being trained as a sex therapist through the Modern Sex Therapy Institute.You can contact Nikita at nikita@mwr.nyc and read more blog posts at www.mwr.nyc.