FAQs about Using Out-of-Network Insurance Benefits
What are out-of-network benefits?
Many insurance plans, especially PPO plans, will help pay for services from therapists who aren’t in their network of covered providers. While you’ll typically pay more than you would with an in-network therapist, your insurance may still reimburse you for a portion of the cost, usually 50-80% of what they consider a reasonable fee for therapy services (called the “allowable amount”) after you meet your out-of-network deductible. Note that insurance companies do not disclose the allowable amount in advance, and it varies considerably based on your specific insurer, plan type, geographic location, and other factors.
How does this help me?
Accessing out-of-network benefits allows individuals to see a wider range of providers while receiving partial insurance reimbursement, reducing their overall out-of-pocket expenses.
How do I know if my plan has out-of-network benefits?
The best way to confirm your out-of-network benefits is to call the customer service number on your insurance card and ask specifically about your out-of-network mental health benefits, including your deductible, reimbursement percentage, and any annual limits.
How do I access my out-of-network benefits?
You’ll pay the full session fee at the time of service to Gabriel Corens LICSW, who will then submit a superbill to your insurance company on your behalf. If your claim is approved, your insurer will send the reimbursement payment directly to you. This complimentary service is designed to simplify the reimbursement process and make therapy more accessible.
How long does it take to receive reimbursement?
Most insurance companies process out-of-network claims within 2-4 weeks, though processing times can vary by insurer and claim complexity. It’s a good idea to check with your insurance provider for their typical processing time.
What if my claim gets denied?
If a claim is denied, you’ll receive an explanation of benefits from your insurance company detailing the reason. While I’m happy to discuss any questions about the superbill information, I’m not responsible for claim denials or reimbursement decisions made by insurance companies.