Using Out of Network Benefits for Therapy

If you have out-of-network benefits, you have two options for navigating the reimbursement process: you can either submit your superbill directly to your insurance company, or I can help simplify the process by using Mentaya, a service that handles the paperwork and submission for you— which I offer at no cost to you.

You can use the Mentaya benefits checker below to see if you have out of network benefits.

Two Ways for Reimbursement using Out of Network Benefits

What is a Superbill?

A superbill is a detailed receipt that includes all the necessary information about the therapy services you received, such as:

• My professional credentials

• The date of service

• The type of therapy provided

• The duration of the session

• The total amount paid

You can submit this document to your insurance company to request reimbursement for the services provided.

Simplify the Process with Mentaya

Mentaya is perfect for you if:

• You have out-of-network benefits

• You feel overwhelmed by superbills and insurance paperwork

• You've submitted superbills before but haven’t been reimbursed

• You simply want to skip the hassle of dealing with paperwork

How Mentaya Works:

1. Sign up for Mentaya: Click here to sign up

2. I enter your session details: I’ll input your session information directly into the Mentaya platform.

3. Mentaya submits the claim: Mentaya will submit the claim to your insurance company and handle any follow-up.

4. You get reimbursed: Once the claim is processed, you’ll receive reimbursement from your insurance company.

The best part? I offer this service at no cost to you, ensuring that you can enjoy a hassle-free experience without worrying about additional fees.

Questions to Ask Your Insurance Company for Out-of-Network Reimbursement

When contacting your insurance company, here are the key questions you’ll need to ask to help facilitate the reimbursement process:

1. Do I have out-of-network benefits for therapy?

2. What is the reimbursement rate for out-of-network therapy services? (This will help you understand what portion of the session cost you can expect to be reimbursed.)

3. What are the diagnostic codes you require for reimbursement?

4. Do I need to submit a claim form, or will the superbill suffice?

5. Are there any limits or restrictions on the number of therapy sessions I can be reimbursed for each year?

6. Do I need to provide additional documentation, such as a treatment plan or progress notes?

7. What is the process for submitting out-of-network claims? (Ask about the online or paper submission process.)

8. Are there any co-pays, deductibles, or out-of-pocket expenses I will need to pay before reimbursement is processed?

9. How long will it take for the reimbursement to be processed and sent to me?

These questions will ensure you have all the necessary information to submit your claim correctly and understand what to expect in terms of reimbursement.

What is an Out-of-Network Provider?

An out-of-network provider, like myself, doesn’t have a direct contract with your insurance company. This means I don’t bill them directly, and you pay for the session upfront. I’ll provide you with a superbill, which you can submit to your insurance for reimbursement.

How Does the Reimbursement Process Work?

1. Pay for your session at the time of your appointment.

2. Receive a superbill: After your session, I’ll provide you with the superbill.

3. Submit to your insurance: You submit the superbill (along with any claim forms, if necessary) to your insurance company.

4. Get reimbursed: If your insurance plan covers out-of-network services, they will review the claim and reimburse you for a portion of the session cost.