Out-of-network benefits: a way to make your therapy more affordable

Not a lot of people know about out-of-network insurance benefits. Basically this is how it goes – you find a therapist online that really seems like a good fit, but then you look at the billing and insurance area on their profile and see that they don’t accept your insurance. Most people would say “Darn, guess I can’t see them and will have to find someone else.” Not necessarily! Instead, what you can do is reach out to your insurance provider and see what your “out-of-network” benefits are. Often it is the case that they provide some amount of reimbursement for therapy sessions. I can provide you with a “superbill” – a form of receipt for services – that you then submit to your insurance provider, and they will give reimburse a portion of the amount you paid back based on the plan that you have.

Insurance plans vary significantly, so understanding your specific benefits is essential. If you're interested in working with me or another therapist outside your insurance network, you may still be eligible for partial reimbursement.

Disclaimer: This information is educational only and does not constitute legal or financial advice. Insurance reimbursement cannot be guaranteed. Direct questions about your coverage to your insurance provider.

Verifying your out-of-network benefits

Step 1 — Contact your insurance provider. Call the Member Services number on your insurance card.

Step 2 — Explain your interest. Inform them you're seeking outpatient mental health services from an out-of-network provider. Have my practice details ready if they request specific provider information (listed below).

Step 3 — Request key coverage details. Ask about the following:

• Deductible: Amount you must pay before coverage begins – you wont be able to receive reimbursement until this is met.
• Out-of-pocket maximum: Your annual responsibility before 100% coverage kicks in.
• Copay/coinsurance: Your cost per session (percentage or flat fee).
• Allowable visits: Annual session limit covered by your plan.
• Allowed amount: The insurance company's approved rate for services (often lower than provider rates).

Example: If insurance allows $100 for a 45-minute session but the provider charges $150, your 80% coverage would yield an $80 reimbursement (80% of $100), not $120 (80% of $150).

Step 4 — Confirm covered CPT codes. Verify coverage for the billing codes I typically use:

• 90837 — 55-minute individual therapy
• 90834 — 45-minute individual therapy
• 90832 — 30-minute individual therapy
• 90875 — Neurofeedback – 30 minutes
• 90876 — Neurofeedback – 45 minutes

Step 5 — Check authorization requirements. Determine if referrals or prior authorization are needed. If so, clarify who can initiate these and the submission method (phone, fax, email).

Step 6 — Understand claims submission. Ask how to submit reimbursement claims and what documentation is required.

Step 7 — Document everything. Record the representative's name and request a call reference number for future verification.

Tips for your insurance call

• Allocate sufficient time: Plan for at least 30 minutes.
• Document, document, document: Have a notepad or a way to write things down, and keep detailed notes of all the information provided.
• Ask questions: You're entitled to understand your benefits—don't hesitate to request clarification.

How out-of-network billing works in my practice

1. Client responsibility. You're responsible for understanding your insurance benefits. While I can't interpret every plan's specifics, I can provide support in helping you navigate this process.
2. Session payment. Payment is collected in full at the time of service.
3. Superbill provision. After each session, I'll provide a superbill—a detailed receipt containing my practice information, the diagnosis codes, the CPT codes, and the payment amount.
4. Reimbursement submission. Submitting the superbill to your insurance is optional. Some clients choose not to file for privacy reasons. The decision is yours.

Practice details for your insurance provider

Your insurance provider may ask you for the following information about my practice:

• Provider’s full name: Joshua Morrow, LLP
• Type 1 National Provider Identification (NPI) Number: 1962122853
• Phone: 517-927-0236
• E-mail: jmorrow@renewpsy.com

Practice addresses:

1. 3830 Packard St Ste 280, Ann Arbor, MI 48108
2. 496 W Ann Arbor Trl Ste 202, Plymouth, MI 48170
3. 27780 Novi Rd Ste 244, Novi, MI 48377

The billing/service (CPT) codes that I most frequently use:

• 90837 – 55 minute individual therapy
• 90834 – 45 minute individual therapy
• 90832 – 30 minute individual therapy
• 90875 – Neurofeedback – 30 minutes
• 90876 – Neurofeedback – 45 minutes