Out of Network Checklist

When a clinician is considered “Out-of-Network,” payment is required at the time of service. You can then request reimbursement from your insurance company.

If you would like to pursue reimbursement, we advise that you contact your member services department to verify if your plan offers out-of-network benefits for outpatient mental health. The number should be located on your insurance card.

If out-of-network benefits are available, you should ask:

  • Claims Address
  • Do I have a deductible?
  • Deductible Amount
  • What is the maximum number of visits per year?
  • What percent of reimbursement is covered under my benefit?
  • What is the reimbursement rate?
  • The most used CPT codes are as follows:
      • 90791-Diagnostic Interview
      • 90832, 90834, 90837 – Individual Therapy (each code has different time requirements)
      • 90846 – Family Therapy w/o Patient
      • 90847 – Family Therapy

If you are having a testing evaluation, the most used CPT codes are as follows:

    • 96130 – Psychological Testing (first hour)
    • 96131 – Psychological Testing (each additional hour)
    • 96136 – Psychological Test administration and scoring (first hour)
    • 96137 – Psychological Test administration and scoring (each additional hour)
  • How do I submit the claim?
  • Is authorization Required? If yes, how do I obtain authorization?
  • Effective and Expiration dates
  • Number of visits
  • CPT codes that have been approved