Questions to Ask Your Insurance Company to Use an Out of Network Provider

  • Do I have out-of-network (ONN) mental health insurance benefits?
  • Do I have a deductible to meet before benefits kick in for out of network providers; what is it, and has it been met?
  • How is my reimbursement determined? What will I be reimbursed?
  • Are there any limitations to the type of mental health services covered or the number of sessions per year?
  • Is prior authorization required? If so, from who and how often do I need authorization? (Some providers give approval for a certain number of sessions and request re-authorization after that number has been met.)
  • Are there any documents I need to submit along with my “statement of services receipt”? (generally, no.)

Why Wouldn’t You Use Your Insurance?

Though it can be of financial benefit to use your insurance, some clients decide not to for privacy reasons. When you use insurance, they have the right to request and review our progress notes, on occasion they may ask me for a case review to evaluate if they will continue to reimburse for our work, and you are required to have a diagnosis. For these reasons, some clients decide they do not want a third party involved in their health and wellness. If you decide not to use your insurance, you will have to sign a document saying you opt out.