How To Use Your Out Of Network Benefits
At Fostering Greatness we are private pay, which means you are responsible for the full session fee at the time of service. However, there are several ways to offset that cost — and you may have more options available to you than you realize.
Below you’ll find three ways to reduce your out-of-pocket costs: using your HSA or FSA funds, automating your insurance reimbursement through our Mentaya partnership, or filing for out-of-network reimbursement directly with your insurance carrier yourself.
Below we walk you through all of your options and lay out the questions to ask your insurance carrier if you choose to file on your own.
Using Your HSA or FSA
If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA) through your employer or health plan, you can use those funds to pay for therapy sessions at Fostering Greatness — including both traditional talk-therapy & ketamine-assisted psychotherapy (KAP) or Spravato-assisted therapy (SAP).
HSA and FSA funds are set aside pre-tax, which means using them for therapy effectively reduces your out-of-pocket cost. For many clients, this makes private pay therapy significantly more accessible than it may initially appear.
To use your HSA or FSA: Simply pay for your session using your HSA or FSA debit card at the time of service, the same way you would use any other payment method. No extra steps required.
Don’t have your card handy? Pay out of pocket and submit your receipt or superbill for reimbursement through your HSA or FSA portal.
Not sure if you have an HSA or FSA? Check with your employer’s HR department or log into your employee benefits portal — many professionals are surprised to find they have funds available that they haven’t been using!
HSA and FSA benefits can be used alongside your out-of-network insurance reimbursement. You can pay with HSA/FSA funds upfront and still submit a superbill to your insurance for partial reimbursement — maximizing both benefits at once.
Let Mentaya Handle Your Insurance Claims Automatically
We’ve partnered with Mentaya to make out-of-network reimbursement effortless. Instead of navigating superbills and insurance paperwork on your own, Mentaya handles everything for you.
Mentaya is a great fit if you:
- Have out-of-network benefits
- Feel overwhelmed by superbills and insurance
- Have submitted superbills before but didn’t get reimbursed
- Simply want to skip the hassle of paperwork
Not sure if you qualify? Check your benefits instantly:
Here’s how it works:
Mentaya charges a 5% fee per claim — which includes handling paperwork, managing denials, and calling your insurance company on your behalf. And it’s completely risk-free: if your claim isn’t successfully submitted, you receive a full refund of their fees.
Important questions to ask your insurance carrier when checking your OON benefits
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:
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.
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
[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.
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.
Care Credit
As an out-of-network provider, Fostering Greatness offers Care Credit as an option to clients to make Ketamine Assisted Psychotherapy more accessible. Care credit offers flexible financing options that allow you to pay over 6, 12, or 24 months with some options including 0% interest if paid in full within the promotional period.
