How Do I Know If I Have Out-of-Network Coverage?

Understanding your insurance coverage can feel overwhelming—but you don’t have to figure it out alone. This guide will walk you through exactly how to check if your plan includes out-of-network benefits for mental health services.

Step 1: Check Your Benefits

The most reliable way to confirm your coverage is to:

  • Call the number on the back of your insurance card

  • Or log into your insurance provider’s website and request a benefits report

Step 2: Ask the Right Questions

When speaking with your insurance provider, it can be helpful to ask the following:

  • Does my plan include out-of-network coverage for mental health?

  • Is there an annual deductible for out-of-network mental health benefits? If so, how much?

  • Is there a limit on the number of sessions covered per year?

  • Is there a maximum out-of-pocket limit per year?

  • What is my co-insurance percentage for mental health services?

  • Do I need pre-authorization for psychotherapy?

  • Do I need a referral for psychotherapy?

  • How do I submit a claim for reimbursement?

Understanding “Reasonable & Customary Fees”

You may also want to ask:

“What is the reasonable and customary fee for my area?”

This refers to the amount your insurance considers a typical or standard rate for services in your geographic location. This number is important because it impacts how much you’ll be reimbursed.

CPT Codes You May Need

Your insurance provider may ask for CPT (Current Procedural Terminology) codes to determine coverage and reimbursement rates.

Here are the most common codes used for therapy services:

  • 90791 – Initial Assessment

  • 90834 – Ongoing Psychotherapy (45 minutes)

  • 90837 – Psychotherapy (60 minutes)

  • 90847 – Couples/Family Psychotherapy

  • 90853 – Group Psychotherapy

  • 90785 – Interactive Psychotherapy

Final Note

If you’re unsure about anything, don’t worry—this process can take a little time, and it’s okay to ask questions or request clarification from your insurance provider.

Taking this step helps you better understand your benefits and make informed decisions about your care.