Out-of-network benefits are insurance benefits that may apply when a member receives care from a provider who does not have a contracted network agreement with the member’s insurance plan. These benefits can allow a client to seek reimbursement for eligible therapy services, but coverage and costs vary by plan.
Important details may include the out-of-network deductible, coinsurance, allowed amount, covered service types, authorization requirements, reimbursement limits, and claim filing deadlines. Some plans provide little or no out-of-network coverage. Confirm the details directly with the insurer before assuming that a therapy session will be reimbursed.