Out-Of-Network Benefits

I see patients with other commercial insurance plans outside of Aetna as well (i.e. United, Cigna, BCBS, etc.) as an out-of-network provider. Patients with these plans may have out-of-network benefits, which means that a substantial portion of sessions can be covered up to 80% (sometimes more) of my standard fee.

I can support you in using your out-of-network (OON) benefits in two ways:

1. Automatic: I can submit OON claims automatically on your behalf via Thrizer, saving you time, effort, & insurance hassles; or

2. Manual: I can provide you with a superbill (a detailed receipt) that you can submit to your insurance for reimbursement.

Understanding Out-of-Network Coverage

You can estimate how much therapy might cost by calling your insurance company and asking them the following questions. These variables get reset annually.

1. Out-of-network Benefits : Do I have coverage for virtual mental health services?

2. Deductible : Do I have a deductible for out-of-network benefits? If so, how much is that and how much of it have I met?

3. “Allowed Amount” : What is the “Allowed Amount” for psychotherapy (CPT code 90834)?

4. Co-pay : Of that Allowed Amount, what will my insurance company pay, and what does the insurance company expect me to pay after I meet the out-of-network deductible?

5. Out-of-Pocket Maximum : What is the yearly out-of-pocket maximum for my policy, and how close am I to meeting it?

6. Session limit : Is there a limit to the number of sessions covered per year?

Knowing this information can help you estimate your out-of-pocket costs more accurately.