Resources

Checking your PPO benefits.

Not sure what your plan covers? This quick PPO benefits calculator gives a rough estimate of your out-of-network reimbursement in a couple of minutes.

For a more exact number, call your insurance company directly. Dial the number on the back of your insurance 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? Your reimbursement is a percentage of this number, not your full fee, which is why it's the one people most often overlook.

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.