Insurance & Out of Network Benefits | Fair Lawn, NJ

Out-of-network benefits allow you to receive care from providers outside your insurance network. While you may pay more upfront, your insurance may reimburse a portion of the costs.

• Deductible – The amount you must pay before your insurance starts covering costs.

• Coinsurance – The percentage of costs you pay after meeting your deductible.

• Out-of-Pocket Maximum – The maximum amount you pay in a plan year before your insurance covers 100% of covered services.

1. Verify Coverage – Contact your insurance company to confirm out-of-network benefits for mental health services.

2. Understand Your Deductible – Know how much you need to pay before insurance begins reimbursement.

3. Check Reimbursement Rates – Ask your insurance provider about the percentage of costs they will cover.

4. Request a Superbill – We provide a detailed receipt (superbill) for each session for you to submit to your insurance.

5. Submit Claims Promptly – File your claims as soon as possible for timely reimbursement.

6. Keep Records – Maintain copies of all claims and insurance correspondence.

When contacting your insurance company, ask:

• Do I have out-of-network benefits for mental health services?

• What is my out-of-network deductible, and how much have I met this year?

• What is my coinsurance for out-of-network mental health services?

• Is there a limit on covered sessions per year?

• Do I need pre-authorization for mental health services?

• Initial Intake Appointment: 90791 (60 minutes)

• Treatment Sessions: 90834 (45 minutes), 90837 (60 minutes)

• Family Therapy: 90846 (without patient), 90847 (with patient present)

• Ensure reimbursement checks are issued to you, not the provider.

• Ask your insurer:

What information is needed to submit a claim?

What is the deadline for claims submission?

How long does processing take?

Can claims be submitted online, or do they need to be mailed?

1. You pay the full session fee at the time of service.

2. I provide you with a superbill containing all required details.

3. You submit the superbill to your insurance company.

4. Your insurer processes the claim and reimburses you based on your benefits.

A superbill is a detailed receipt containing:

• Provider Information – Practice name, address, tax ID

• Patient Information – Name, address, date of birth

• Diagnosis Codes – ICD-10 codes for your diagnosis

• Procedure Codes – CPT codes for provided services

• Date of Service – Date of each session

• Charge Amount – Fee per session

• Submit claims after each session.

• Double-check information before submission.

• Keep copies of all claims and insurer correspondence.

• Follow up if you don’t receive a response within 30 days.

• Be prepared to appeal if a claim is denied.

Insurance policies can change yearly or mid-year. Review your benefits at the start of each year and any time your insurer notifies you of updates.