Out-of-Network Insurance Reimbursement

If you would like to use your health insurance benefits to help cover the cost of an evaluation, follow these steps to check whether your plan includes out-of-network coverage:

Step 1: Call the Member Services Number

  • Look on the back of your insurance card for the Member Services or Customer Service phone number.

  • Call this number and let them know you’re inquiring about out-of-network benefits.

Step 2: Provide Key Information

  • Tell the representative you are seeking psychotherapy or a neuropsychological/psychological evaluation (whichever is applicable) and want to know if your plan offers out-of-network coverage for this service.

  • Be ready to provide the following details:

    • CPT Codes for Evaluations: Ask about coverage for these commonly used testing codes:

      • 96116 (Neurobehavioral status exam – clinical interview)

      • 96136 and 96137 (Test administration and scoring)

      • 96132 and 96133 (Test interpretation and feedback)

    • CPT Codes for Psychotherapy: Ask about coverage for these commonly used testing codes:

      • 90791 (Psychiatric diagnostic evaluation)

      • 90834 (Psychotherapy - 45 minutes)

      • 90846 (Family psychotherapy without the patient present - 50 minutes)

      • 90847 (Family psychotherapy with the patient present - 50 minutes)

    • Diagnosis Code: If you have a referral or prior diagnosis, you may be asked for an ICD-10 code (your provider can assist with this).

Step 3: Ask These Questions

  • “Do I have out-of-network benefits for outpatient psychotherapy or neuropsychological/psychological testing?”

  • “Is pre-authorization or a referral required?”

  • “What is my deductible, and how much has been met this year?”

  • “What percentage of the allowed amount is reimbursed for out-of-network services?”

  • “Is there a maximum allowable amount for psychotherapy or neuropsychological/psychological testing?”

  • “What documentation is required to submit for reimbursement?”

Step 4: Submit for Reimbursement (If Eligible)

  • For evaluations, If you have out-of-network benefits, you will typically pay the full fee up front to Beacon Light Psychological Services. After the feedback appointment, we will provide a superbill (detailed receipt) containing all necessary codes and information for you to submit to your insurance company for potential reimbursement.

  • For psychotherapy, we can send a superbill on a monthly basis.

  • Please note that we are happy to provide superbills, but we do not directly contact insurance companies.