Checking Out-of-Network Benefits With Your Insurance Provider

When considering a therapist or health practitioner, you can choose between out-of-network and in-network. Out-of-network does not always have any agreement with the insurance company, but in-network has. In most cases, if not all, the PPO(Preferred Provider Organization) network, a health plan that aids in contracting with medical providers, maintains network directories that mention all the medical providers in the network. Thus, if the provider is not on the list, they will be out-of-network. It is essential to check on the out-of-network benefits with the PPO to be informed. 

 Not sure how to check out-of-network benefits? Then consider these steps:

1. Checking the Out-of-network Benefits on the Summary of Benefits.

To be sure of the benefits, you can look at the summary of benefits which is included in the member information packet, or you can sometimes find it on the insurance company website. When looking at the summary of benefits, it is essential to learn more about the out-of-network deductible, which is usually the money one must pay before one becomes eligible for reimbursement. It is also crucial to know that deductibles are reset annually. Hence any health expense a person pays out of pocket contributes to meeting the services.

2. Call the Insurance Organization to Verify the Benefits

There is need to seek clarification from the insurance company. You can reach them through the member services line. Their contacts are usually on their online insurance platform or the back of your insurance card. And to be fully equipped with the information concerning the out-of-network rewards, inquire about multiple things.

  •  The total amount of your after-tax.
  • Concerningnetwork deductible
  • All theout-of-network coinsurance you get as an outpatient.
  • How you can submit claim forms for reimbursement.
  • Does an in-network provider provide referrals and do you need it?

3. Inquire About a Superbill from Your Therapist

When considering a therapist, it is essential to inquire if they can submit claims through the PPO networks to the insurance company for reimbursement. Even though some therapists consider offering it, it is best if the client is responsible for submitting claims. Usually, the therapist gives you a document referred to as a superbill. You can consider submitting it directly to the insurance company at the end of every month. The superbill details the number of sessions you’ve had and the total fee to pay.

4. Receiving Network Reimbursement

You must pay the therapist the entire session fee during the service. But that will depend on your PPO network plan. And for that case, your insurer will mail you a check to reimburse a particular portion of the cost.


A person can avoid unexpected medical bills through planning. The choices you make get to affect what you will pay. Health plans can offer access to a network of facilities, doctors, and pharmacies which can help you save money. But by choosing out-of-network, you will have no contract with your health plan, and you can pay the total price.