HOW TO CHECK OUT OF NETWORK BENEFITS

 

• You will need to know your name, date of birth, and member ID before calling. It’s good to

have your member card available to provide the customer service representative with any

applicable information needed.

 

• Always write down the number you called, the name of the person you spoke with, the date,

start time, and end time of the call, and relevant notes of the call, including reference numbers

and case numbers.

 

• Select the option about benefits or eligibility and do your best to get a live person.

 

• When speaking to a rep, state that you are “looking to work with an out of network provider for

outpatient office and online psychotherapy” and want to know your “out of network benefits for

psychotherapeutic services.” You are not looking for medical services or inpatient services.

 

• Should they ask for my credentials, you can tell them I am an LCMHC.

 

• They will then tell you what your benefits are. Write those down. If you do not have any out of

network benefits, you will generally not be able to be reimbursed for services. If you do have

out of network benefits, ask if the following codes are covered: 90791, 90834 and 90837.

 

• Ask them how you go about getting reimbursed. Do you need to fill out a form? Submit a letter

with a receipt? What kind of documentation do you need to give them? Where do you need to

send it? How long do you have to submit? (it is typically 90 - 365 days).

 

• Tell them you will be paying the provider up-front and insure that they will be reimbursing YOU

and not ME.