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OUT-OF-NETWORK REIMBURSEMENT CHECKLIST:

Many people can obtain out-of-network reimbursement for a portion of their fees paid.  You can use this checklist to help estimate how much your insurance company may reimburse. 

 

Contact your member services department to verify if your plan offers out-of-network benefits for outpatient mental health. The number should be located on your insurance card.

 

The State of Virginia has parity laws for telehealth so this should not influence reimbursement.

 

If out-of-network benefits are available, you should ask the following: 

 

  1. Claims Address?

  2. Do I have a deductible?

    1. YES or NO Deductible Amount?

  3. What is the maximum number of visits per year?

  4. What percent of reimbursement is covered under my benefit? 

  5. What is the out-of-network reimbursement rate for the following prcedure codes:​

    1. 90833 - (25 min psychotherapy; E/M)

    2. 90836 - (45 min psychotherapy; E/M)

    3. 99214 - (moderately complex - follow up visits.)

    4. 99215 - (Complex initial visits.)

  6. How do I submit claims?

  7. Is Authorization Required, YES or NO?

    1. How do I obtain authorization?

    2. Effective date?

    3. Expiration date?

    4. Number of visits?

    5. Procedure Codes Approved?