Here at Ample + Rooted, we are an out-of-network provider. This means that we aren’t in network with any insurance, but that doesn’t mean you can’t still use your insurance benefits. You just might have out-of-network benefits that are waiting to be used. While you’ll be responsible for your session fee upfront, you might be able to get reimbursement from your insurance company. You can check to see if you have these benefits and below we’ll walk you through a few of them.
On your insurance company website, you can find your Summary of Benefits. While reading through your plan’s summary look for phrases like “out-of-network deductible” and “coinsurance.”
Your out-of-network deductible is how much you have to pay before you can access your out-of-network benefits and be reimbursed. For example: your deductible is $500 and once you pay that amount your insurance company will cover 100% of services. You’ll have met your deductible after you pay $500 and will be eligible for reimbursement.
This means that if you spend $1,000, you’ll be responsible for $500 of that and then your insurance company will reimburse you for all or a portion of the remaining $500. This is normally in the form of a check and is mailed directly to you after you submit a claim. (Note: you will still have to pay for your sessions at the time of service.) Your deductible will reset at the beginning of each year but every out of pocket health expense you have to pay will go towards meeting your deductible.
Coinsurance is the portion of the service fee that you will have to cover. If your therapists’ session fee is $140 and your coinsurance is 50%, you are responsible for $70 and your insurance will reimburse you the other $70. Your coinsurance doesn’t kick in until you reach your deductible so you will have to pay the full session fee until you’ve done so.
If your insurance company has an allowed amount, this means there’s a max that they will pay. Let’s say your allowed amount is $140 for each session, your coinsurance is 50%, but your therapists’ fee is $200. In this case your insurance company will only cover a max of $70 and you will have to pay $130.
While going online is definitely the easiest option, calling your insurance company directly can provide you more direct and accurate clarity on understanding your benefits. On the back of your insurance card you’ll see a phone number for member services. Sometimes mental health benefits are contracted through another company so your insurance company may give you another number to call or transfer you straight to them.
Here are some questions you can ask when you call:
Do I have any out-of-network benefits?
How much is my mental health deductible and has it been met yet?
Do I have a coinsurance and if so, how much is it?
Will I need a referral in order to see a provider that is out-of-network?
How can I submit a claim to be reimbursed?
Some therapists have the option to give you something called a Superbill. This is essentially a fancy receipt with all the information your insurance company will need to file a claim. Once you get your Superbill from your therapist you can then use it to submit a claim for reimbursement.
There are several ways to file a claim for reimbursement. Some insurance companies require you to do it through their website but you may also be able to use an app. There are a few options, the most common being Reimbursify. Reimbursement apps will help you through the process of filing claims, though they may charge a small fee.
Seeing an out-of-network provider can be beneficial for many reasons, especially if they have a speciality like we do here at Ample + Rooted. We’re proud to say that we can provide you with a Superbill for all services rendered and our admin team is always available to answer any questions you may have!
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