Insurance Guide: Navigating Out-of-Network Benefits

If you contact your insurance company directly to clarify your out-of-network benefits, you’ll find helpful information and questions below to guide you. You can also use this tool to check if you qualify for reimbursement for my services.

Insights on the benefits of private pay.

Step 1: Gather Information

If you choose to contact your insurance directly, have the following ready:

Your Information

  • Insurance Phone Number:

  • Client’s Name:

  • I.D. # on Card:

  • Insured’s name:

  • Insured’s I.D. #:

  • Relationship to Insured:

  • Group/Account Number:

  • Insured’s Date of Birth:

  • Client’s Date of Birth:

  • Insured’s Employer

Life Edit Therapy Insurance Information

Mental Health Provider’s Name:  Marla Field, MA, LLP 

Provider’s Business Address: Life Edit Therapy, 9383 Klages, Road, Brighton, MI 48116

Provider’s National Provider Number (NPI):  1285177881

Provider’s Employer Identification Number (EIN): 85-2649422

CPT Codes that May be Used:  90834, 90837, 90846, 90847, 90791 (You may want to ask if these are covered.)

Location:  10- Telehealth in Client’s Home or 02 - Telehealth Outside of Home

Modifier Used:  95

Step 2: Call Insurance with These Questions

1. Does my plan include out-of-network,  telemental health (online video) coverage?

If yes, continue to the following questions. 

2. Do I have a deductible for out-of-network telemental health?

  • Is there a separate deductible for in-network services and out-of network services?

  • How much is it (or how much are they)?

  • When does the deductible (or deductibles) reset?

  • How much of my deductible has already been met? (If you have a deductible for in-network and out-of-network services, ask how much of each one has been met.)

  • Is the deductible (or deductibles) currently being waived due to COVID-19?

  • If yes, until when?

3.  Do I have a copay or coinsurance for out-of-network telemental health?

  • If yes, what is my copay or coinsurance?

4. What is the telehealth modifier my provider needs to use on the superbill?

5. If you have coinsurance, ask what the allowable amount is for the following:

  • 90791 (Intake Session)

  • 90837 and 90834 (Individual Sessions)

  • If you are seeking couples counseling, also ask about the following regarding coinsurance:

  • 90847 (Family Therapy)

  • 90846 (Family Therapy without the patient present)

6. If you have coinsurance: also ask Is it currently being waived due to COVID-19?

  • If yes, until when?

7. Do I need pre-authorization for telemental health services that are out-of-network?     

  • If yes, what is the process for getting a pre-authorization?

  • Will I be limited to a certain number of sessions?

  • (If services are authorized, make note of the number of sessions authorized along with the expiration date.)

8. Do I have an out-of-pocket maximum?

  • If yes, what is my out-of-pocket maximum?

  • When does it reset?

9. What is the easiest or most efficient way for me to submit my claims?

  • If you can submit by paper only, make sure to ask where you can find the forms.  

  • If you can submit online, clarify the web address where you can submit claims.



The information above was in part based on the work of Barbara Griswold, LMFT
Author, Navigating the Insurance Maze:  The Therapist’s Complete Guide to Working With Insurance 
www.theinsurancemaze.com