Submitting an OON Claim
Learning about what this means can be confusing, therefore (thanks to many others who do the same), I have been able to compile a list of how to’s when it comes to submitting an out of net work claim.
Filing an out-of-network reimbursable claim
Although I am not an in-network provider with your insurance, you are still able to use your benefits by filing a reimbursable claim. When you select this option, your insurance carrier will reimburse you for a percentage of the cost of therapy. You will be responsible for paying the full session fee at every session, regardless of annual household income, then submitting a claim to your insurance carrier for partial reimbursement. At the end of sessions I will provide something called a “super bill” that you will than submit to your insurance company for the claim.
Questions to ask your insurance carrier
While many insurance companies will allow you to go this route, it is still important that you contact your specific insurance company and see what their rules and policies are. Here is a list of helpful questions to ask your provider.
- Will they accept out-of-network claims for psychotherapy?
- What is your annual out-of-network deductible for mental health services, and does this deductible include your other medical expenses? This is the total amount you will have to pay out of pocket before your insurance carrier reimburses you for sessions.
- What is your coinsurance rate?
- This is the percentage of each session fee your insurance will reimburse after you’ve met your deductible for the year.
- What is your out of pocket maximum?
- Once you’ve paid this amount out of pocket for the year, insurance will reimburse you 100% of the full session fee.
- What is the best way to submit a claim (along with a Superbill) to your insurance carrier?
- A Superbill is a summary of how much you’ve paid for each session. I can provide this to you after each session, or after a few sessions (i.e., at the end of every month).
HOW DOES THIS WORK? When you submit a claim form and Superbill to your insurance carrier, the amount you’ve paid for therapy goes toward your annual out-of-network deductible. After you’ve paid the entirety of this deductible, your insurance carrier will begin reimbursing you for each session according to your coinsurance rate. Once you’ve paid your yearly out of pocket maximum, your insurance carrier will begin reimbursing you 100% of the amount you’ll pay for each session.
HOW MUCH WILL I ACTUALLY PAY? Ok lets look at an example. You are seeking individual therapy with me and you call your insurance company and they tell you that your deductible is $1200/year, your coinsurance is 60%, and your out of pocket maximum is $7,000. (Every plan varies, which is why you need to verify these amounts with your specific carrier; please remember these numbers are just an example only!) You’ll pay me the full session rate of $85 for each session, then submit a claim and a Superbill for those sessions to your insurance carrier. With a $1200 deductible, you’ll end up paying for 14 sessions without getting reimbursed, although all of those payments will go toward meeting your annual out-of-network deductible. Once you’ve met your deductible, your insurance carrier will reimburse you 60% (i.e., your coinsurance rate) of my full session fee for every session (60% of $85= $51) making your final out of pocket payment only $34/session! Now thats an amazing rate!
GETTING THE MOST OUT OF YOUR COVERAGE Depending on your other medical expenses for the year and how quickly you meet your deductible and out of pocket maximum, submitting claims this way can make therapy very affordable.