We are out-of-network providers for insurance companies. Our clients either utilize the out-of-network benefits from their insurance plan, or pay completely out of pocket. Clients will pay for each session and by the end of each month we will provide a detailed document (called superbill) for clients to submit to insurance for out-of-network coverage. The coverage for our-of-network services may vary depending on insurance plans, you can contact your insurance company and ask about the out-of-network reimbursement rate. Below are some questions you can use to ask your insurance company for detailed information.

• No restrictions on how many sessions per year or how often you get to see your therapist.

• No restrictions on the length of sessions and the type of service needed.

• No requirement to have a diagnosis, and if there’s a diagnosis, it can remain confidential.

• No need to share your mental health information with insurance companies.

• No time wasted on calling and waiting in line to speak with insurance company representatives.

• No restrictions on telehealth/online therapy.

• No need to change your therapist if you change your insurance plan with work.

• Freedom to choose a therapist who can be the best fit for you instead of being limited to therapists who are within network of insurance companies.

• You will have a payment method on file, which will be utilized to pay for services.

• By the end of each month, we will send you superbills with information insurance companies need for out-of-network claims.

• You submit the superbills on your insurance company websites (log in and submit under “Claims)

• Insurance companies will send you information about the coverage and direct reimbursement for the services utilized.

• We have observed that some insurance companies initially denied mental health service claims with the assumption that consumers may accept the denial of coverage. However, it is your right to appeal the denial. It is to your benefit to obtain information from insurance companies about the reasons for denial and submit information as needed to re-process the claims.

• Here are 2 websites that can help you get a better understanding and make the most out of your out-of-network benefits: 1. For detailed coverage information (https://calculator.meetnirvana.com/); 2. To make the most out of your out-of-network benefits (https://www.mentaya.com)

• Do I have out-of-network coverage for outpatient mental health services?

• If yes, what is the coverage for before and after I reach my deductible?

• How much is my annual deductible? How much has it been met this year?

• Does my expenses with out-of-network providers count towards the deductible?

• What is the specific percentage or dollar amount coverage for out-of-network outpatient mental health services? (You can use the CPT code 90791 for intake and 90834 or 90837 for on-going sessions to check the specific coverage).

• Is telehealth/online therapy covered by my out-of-network benefits?

• (If interested in relationship therapy) What is the out-of-network coverage for family therapy (use CPT code 90847)?

• (If interested in psychological assessment) What is the out-of-network coverage for psychological assessment (use CPT code 90791, 96132, 96133, 96136, 96137)?

• (If psychological assessment is not covered by your insurance) What preauthorization do I need to obtain coverage for out-of-network psychological testing? What documentation is needed?

• What information do you need for me to submit for out-of-network reimbursement?

• Do I need a referral to see out-of-network providers? If so, where can I get the referral?

There are a few ways to find out how much your insurance will cover for out-of-network services.

1. Look for Out-of-Network benefits section for mental health services on your insurance benefit document.

2. Call the customer service number on the back of your insurance card, and ask the agent about your out-of-network benefits using the CPT numbers we provided in the question above.

3. Use this website: https://calculator.meetnirvana.com to find out how much your insurance will cover for the services.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate.

Check out our blog post Understanding In-Network vs. Out-of-Network Healthcare