OON Benefits How To Guide

How to find out what OON benefits you may have:

Utilizing your out of network benefits, should you have them, means that after paying Fostering Greatness upfront for the cost of your therapy session, you then submit the “superbill” to your insurance company (typically through your member portal online) and your insurance company will then reimburse you a portion of the session fee you paid, per your plans terms. Typically a deductible and/or coinsurance does apply and therefore this can impact your reimbursement.

The best way to verify if you have out of network benefits is to call the number on the back of your insurance card and speak to your insurance carrier.

Important questions to ask your insurance carrier when you call:

  1. Do I have out of network benefits for outpatient mental health services?

Your insurance company may ask you what the “service code” is. If they do, you can give them the following codes that apply to the therapy you are seeking:

90791: Intake Session

90834: Individual Therapy Session; Preparatory Session for KAP

90837: Ketamine-Assisted Psychotherapy (KAP) Session

90847: Parent-Child Session or Couples Session

90846: Parenting Session or Couples Session with only one member present

90832: This code is used when the session time is under 38 minutes & therefore this code will only be used if you arrive late to your session or for any other reason the session time is below that threshold.

  1. Are telehealth services through HIPAA compliant platforms eligible for reimbursement?

  1. What is my deductible? Do I have coinsurance that will apply?

[A deductible is the set amount you pay, per year, for medical services and prescriptions before your health plan begins to share in the cost. Coinsurance is the portion of costs you pay after you’ve met your deductible].

If you are on an insurance plan with other members of your family you will want to specifically ask if there is a separate individual and family deductible. This will impact whether your family members’ usage of your insurance counts towards your deductible or not, which will impact how soon the insurance company will begin reimbursing you if you have a deductible.

You can ask whether your deductible has been met already or where it currently stands.

  1. What percentage of the therapy session fee is reimbursed after the deductible is met? Is this percentage calculated from the fee the therapist charges me or a “usual and customary” rate?

A ‘usual and customary’ (UCR) rate is a dollar amount your insurance company has determined is the appropriate amount for the service (in this case therapy) based on the geographic area and what they determine the providers in the area usually charge. This rate is often difficult to obtain from insurance companies, as they prefer to keep this number secret. However, it is important to know if your insurance company uses a UCR as this may change the amount you are reimbursed. For example, if your insurance company says they will reimburse you 50% after your deductible is met, you will want to know if that is 50% of what you were charged for your therapy session or 50% of the UCR rate they have decided.

  1. How do I submit a claim for my out of network benefit?

Please note that I cannot guarantee reimbursement from your insurance company.