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How to Get the Most From Your Out-of-Network Mental Health Insurance Benefits

When searching for a therapist, the common wisdom is to work with one who is in-network versus one who is out-of-network. In-network therapists are already connected to your mental health insurance insurance provider, have a set rate, and are typically more affordable than out-of-network therapists. But what if your in-network therapist moves out-of-network? Or you can’t find an in-network therapist close to you? What do you do if your in-network options are booked to capacity with long waiting lists? Being open to an out-of-network therapist can help ensure that you find the right therapist for you.

If you have mental health insurance and you want to see an out-of-network therapist, below are 5 helpful tips on how to get the most out of your benefits:

1. Find a therapist who accepts out-of-network insurance

For many people, working with an out-of-network therapist enables them to get treatment and therapy appointments much faster than if they were to go with an in-network therapist. While it’s true that navigating out-of-network benefits can take a little more time, it can save you a headache in the long run. 

Nirvana Health is happy to refer you to our network of trusted therapists who use our services to help patients maximize their out-of-network mental health insurance benefits. Nirvana helps therapists understand  your mental health insurance benefits through tools like our insurance coverage calculator. We also handle claims submission on behalf of your therapist, and automatically get you reimbursed for your therapy sessions.

1. Check your out-of-network mental health insurance benefits ahead of time

It’s a good idea to become familiar with the process of using your out-of-network mental health insurance benefits and know how they work so you can prevent any surprise expenses. Because you are working with an out-of-network therapist, you will most likely need to pay for your therapy up front and then wait for your insurance company to reimburse you for a portion of the cost.

You can usually find an overview of your out-of-network benefits in the information packet on your mental health insurance company website under the title “Summary of Benefits.” Look for the term “out-of-network deductible”. This refers to the amount of money you must pay before you are eligible for reimbursement. These deductibles will reset each year so it’s important to keep your plan’s rollover date in mind when you are budgeting for your care. 

2. Call your insurance company to verify your mental health benefits

After you check your insurance company’s website, it’s important to take the time to call your insurance company to confirm that you understood the website correctly. You can find their phone number on your insurance card. Questions you should ask include:

  • How much of my deductible has been met this year?
  • What is my out-of-network deductible for outpatient mental health services? 
  • How do I submit claim forms for reimbursement? 

4. Get a Superbill from your therapist

When you are on the hunt for a therapist, ask them if they are willing to submit claims to your insurance company for reimbursement. Some therapists offer this, but typically an out-of-network therapist will require clients to submit their own mental health insurance claims. Each month, your therapist will give you a document known as a superbill. The superbill is a receipt for the care you received that month and will include details about how many sessions you’ve had and the total costs. You will send the superbill directly to your insurance company to request reimbursement for your care.

5. Get reimbursed from your mental health insurance provider

You will need to pay for the total cost of your session up front, but depending on your out-of-network benefits, your insurance company will mail you a check to reimburse a portion of the cost. This is why it’s important to always send in your Superbill!

Have More Questions? Nirvana Can Help! Our team is here to support you in your journey with therapy. Feel free to contact us here. We aim to return all emails within 1-2 business days.