How do I know what I owe per appointment / what my out-of-network benefits are?

Out-of-network clients are responsible for paying the full cost of sessions upfront, and any coverage will come in the form of a reimbursement check from your insurance company based on your plan’s out-of-network benefits.

For the most accurate and up-to-date information, we encourage you to call the Member Services number on the back of your insurance card to verify your benefits directly with your insurance company.

For out-of-network benefits, you'll want to inquire about the following:

• Out-of-Network Deductible
  The amount you'll have to pay out-of-pocket before your plan covers any portion of your appointments. This number usually ranges from $250 to $5,000.
• Allowed Amount
  The maximum dollar amount your insurance company will recognize as the value of a given service. This number can vary by zip code, procedure code (usually 90837 or 90834), and sometimes diagnosis. This number will not be displayed on the plan documents you receive from your employer or plan administrator. 
• Out-of-Network Coinsurance Rate
  A percentage, usually ranging from 10-50%, indicating your responsibility per session. However, coinsurance rates are applied to the Allowed Amount, not the full cost of a Two Chairs appointment.
• If there are different rates for telehealth video sessions vs. mental health outpatient office visits.

To calculate how much your insurance company will reimburse you per appointment, determine your insurance company's coinsurance responsibility.

For example, if your coinsurance rate is 20%, the company’s responsibility is 80%. In this case, the insurance company should reimburse the portion they are responsible for, which is 80% of the Allowed Amount.

Let’s say the Allowed Amount is $150, so the insurance company should reimburse $120 per appointment (80% of $150) once you’ve met your deductible. Your adjusted out-of-pocket cost then becomes the remaining amount after your reimbursement (full session fee minus the amount you are reimbursed).

Please note: The numbers provided are for example purposes only.