Procedure for Out-of-Network Benefits

If you’re using your out-of-network benefits to pay for your appointment, the process is simple. Following each appointment I will provide a special receipt (known as a superbill) showing you paid and all the details the insurance company typically needs. From there, you simply submit the receipt and any insurance specific paperwork for out-of-network treatment to the insurance company, who will then directly reimburse whatever percentage of the fee they cover based on your plan. If you need any assistance with the forms, please reach out and I would be more than happy to help. Additionally, here are some of the steps you may have to take ahead of our first appointment to verify coverage.

• Call Member Services (the number is typically on the back of your insurance card) for your plan and ask if you have out-of-network coverage for behavioral health care

• If you do have out-of-network benefits, there is probably a deductible and after that is met, a certain percent of the fee will be paid for by the insurance company

• Therefore, the second question for Member Services is what is my annual deductible? Sometimes deductibles are small and other times quite large - totally depends on the plan

• Also inquire as to when the deductible resets annually so you are aware when you will have to start paying towards it again

• Ask Member Services what percentage of the fee they cover for out-of-network behavioral health care once your deductible is met

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The insurance company might ask you for some of my information in order to tell you what percent they will reimburse you. Typically, this includes:

• My zip-code - 13066

• Level of education - Masters of Arts

• State license number - New York 001626

• Procedure code(s) - 90791 (intake) & 90837 (follow up appointments)

• NPI# (National Provider Identifier) - 1821583436