Resources

Checking your PPO benefits.

The fastest way to check is through this PPO benefits calculator, which gives a rough estimate in a couple of minutes.

The most accurate way is a quick call to your health insurer. Call the number on the back of your health card, ask for member services, and say you want your out-of-network outpatient mental health benefits. Then ask:

Out-of-network (OON) benefits

Do I have OON benefits for outpatient mental health? If the answer is no, your plan won't reimburse, and it's good to know up front.

Your deductible

What's my OON deductible, and how much of it have I met this year? This is what you pay yourself before any reimbursement starts.

Your coinsurance

Once I've met it, what percent of each session do you reimburse? This is often somewhere around 50-80%.

The allowed amount

What's the allowed amount for CPT code 90837? This is the one most people miss, and it's the important one.

Why the allowed amount matters. Your plan doesn't reimburse a percent of what you actually paid. It reimburses a percent of what it decides a session should cost, called the "allowed amount". So if a session is $250, your allowed amount is $175, and the plan covers 70%, you get back 70% of $175 (about $122), not 70% of $250.