Out of Network Benefits
Understanding Your Out-of-Network Health Insurance Benefits
What is Out-of-Network Health Insurance Benefits
OON “out-of-network benefits” or coverage means that if you want to see a provider that is not in your insurance company’s network, your insurance may provide partial or total coverage. Each health insurance plan is different, and the best way to determine if you have out-of-network benefits is to call and speak with a benefits representative at your insurance company directly. The representative you speak with should be able to explain the details of your plan, as well as provide you with the necessary instructions to use your benefits.
I encourage you to have something to write with to document the date, the representative’s name, their ID number, and call confirmation number. This will also be helpful in case we need to appeal or challenge a claim. Sometimes there are different providers for behavioral health and medical care existing under one insurance plan who may oversee your mental health benefits. Please keep in mind that you may have to call to confirm which provider manages your behavioral health benefits if your insurance card does not show it. You will find contact information needed on the back of your insurance card. Some insurance providers have online portals their members can use to check their benefits, as well. You may also be able to download a copy of your insurance card, should you not have one handy.
Requesting information about your insurance coverages.
Ask the benefits representative to explain what your out-of-network benefits are. Is there a deductible, or is there an annual visit maximum amount? Ask the representative to confirm the requirements to use out-of-network benefits. For example, they may insist you pay the full fee out-of-pocket, and then submit a completed Health Insurance Claim Form (Superbill). In this case, you would receive the reimbursement check directly. It is also important to confirm the processing time once a claim form or invoice is submitted, so you can plan accordingly.
If your plan is an HMO (Health Maintenance Organization) they may have more in-depth requirements to go outside of the network, and want to pay me directly. Again, each plan is different. Take detailed notes, do not hesitate to ask clarifying questions, and feel free to contact me for any help along the way. Once you understand your benefit options and how to use them, please email m all the requirements at jennifer@mending-hearts.com. If you need help checking your insurance coverage please complete the form. Please allow us 7 business days to respond.