Determining Out-of-Network Insurance Benefits

  • 1. Get in touch with your insurance company

    Call the member services number on the back of your insurance card or on their website.

  • 2. Clarify your benefits, deductible, and how much you will be reimbursed

    Ask your representative:

    • Does my plan include out-of-network benefits to see an outpatient psychiatrist?

    • How many certified visits do I have every year to see my psychiatrist?

    • Do I have an annual deductible for out-of-network mental health services?

    • If I have a deductible, what is the remaining amount I have to pay before I start to get reimbursed for out-of-pocket fees?

  • 3. Clarify how much you will be reimbursed per visit

    Ask your representative:

    • What amount will my plan reimburse me for the service code 99205 + 99417 with a psychiatrist? (Initial consultation)

    • What amount will my plan reimburse me for the service code 99214 +/- 90833 or 90836 with a psychiatrist? (Follow up: Medication visit with therapy)

    • What amount will my plan reimburse me for the service code 90834 with a psychiatrist? (Follow up: Therapy visit without medications)