I am currently paneled with CareFirst BCBS and Johns Hopkins EHP insurances. For all other health insurance plans, I am an “out-of-network” provider. I provide detailed receipts to all of my clients at the end of each month, and these include all of the information needed to submit a claim to your insurance company for possible reimbursement.

Here are some questions to ask your insurance company about your out-of-network benefits:

  • Do I have out-of-network mental health benefits?
    • What amount will I be reimbursed for a 90-minute individual psychotherapy intake session (CPT Code 90791) with an out-of-network provider at a fee of $200?
    • What amount will I be reimbursed for a 55-minute individual psychotherapy session (CPT Code 90837) with an out-of-network provider at a fee of $150?
    • What amount will I be reimbursed for a 55-minute individual psychotherapy session via telepsychology (CPT Code 90837-95) with an out-of-network provider at a fee of $150?
  • Do I need to meet a deductible each year before I can begin to receive reimbursement for sessions with an out-of-network provider?
  • Do I have a session limit for psychotherapy with an out-of-network provider?
  • Is pre-authorization required for psychotherapy with an out-of-network provider? If so, what documentation is necessary? Does my provider need to fill out specific forms?
  • How do I go about submitting out-of-network claims to the insurance company?