Out-of-Network

Insurance, as many of us know, is confusing as fuck.

Something not many people may realize is utilizing out-of-network benefits.

Not all insurance plans have OON benefits. HMO (Health Maintenance Organization) insurance plans often doesn’t carry OON benefits while PPO (Preferred Provider Organization) insurance usually does.

Now, insurance companies would prefer to dissuade you from using your OON benefits because it usually means they’ll have to pay more to the provider instead of if the provider was in-network. Insurance gets to decide how much a provider gets paid if they’re in network, not the case if the provider is out of network.

Many, but not all, OON benefits come with a higher deductible for this reason.

However, it’s important to ask what your plan coverage looks like and see what options are available to you, especially of your provider is private pay. It might be better coverage than you think.

Here ‘s what you can do to find out more about your OON Benefits:

• Call your insurance provider (either the Behavioral Health number on your card, or the general number).

• Speak with a representative and ask about your OUTPATIENT, OUT-OF-NETWORK BEHAVIORAL HEALTH benefits.

• Document the Representative’s name, date and time of call and ask the following questions:

• Do I have Out-of-Network Benefits for therapy?

• Do I have a deductible? If yes, how much? And amount met this year?

• Is my plan based on a calendar year or benefit year? If Benefit Year, what are the coverage dates?

• What is my co-pay or coinsurance for OON mental health services?

• Do I need a referral to see an out-of-network provider?

• How do I submit a claim for reimbursement?