A Step-by-step guide to out-of-network benefits

When looking for a psychiatrist, you have the option to choose between in-network and out-of-network providers. In-network psychiatrists have negotiated a contracted rate with your health insurance company; as a result, they are typically more affordable than out-of-network psychiatrist. However, there are many benefits to consider for seeing an out-of-network psychiatrist.


While finding an in-network psychiatrist is often the default choice, including out-of-network psychiatrists can help expand your search and the likelihood that you can find a psychiatrist you will be happy and comfortable with. This is especially true in big cities like Los Angeles (especially on the westside), where psychiatrists who take insurances tend to be booked to full capacity and have long wait times for appointments.



If the psychiatrist you’re seeing, or want to see, is not in your insurance network, then you will have to pay the full price of the appointments upfront. Fortunately, depending on your plan, your insurance company may reimburse a portion of the cost by mailing you a check. For example, most PPO and POS health plans offer partial reimbursement for out-of-network services.


Use the following steps to learn how out-of-network benefits work. Though navigating out-of-network benefits can feel cumbersome, it be much easier than you think to find a psychiatrist who better fits your needs, using out-of-network benefits.


  1. Check your out-of-network benefits

The first step is to call your insurance company (the number should be on the back of your ID card) and ask if they provide coverage for “out of network Psychiatry”.


You should additionally ask the following questions:

1) What percentage of the costs they will reimburse?

2) Do I have a deductible? If so, how close am I to reaching it this year?

3) Will they reimburse based on my doctor’s fees or will reimbursement be adjusted to

a percentage of the rates that they set?


You may need to provide the following information:

1) Dr. Goldenberg is a physician

2) The billing code to be used for the initial visit- CPT Code: 90792

3) The billing code for most medication management follow up visits- CPT Code: 99214


  1. I will provide you a Superbill at your request

When you’re looking for a psychiatrist, ask if she or he is willing to provide you a document called a Superbill that you send directly to your insurance company in order to receive reimbursement. The Superbill details how many sessions you’ve had, and the total fees that you have paid.


  1. Receive out-of-network reimbursement!

You’ll need to pay your psychiatrist the cost of the appointment fees at the time of service, but depending on your specific plan, your insurance company will mail you a check to reimburse a portion of that cost.


If you want to learn more about the benefits of seeing an out of network psychiatrist, read more here


Stay Tuned! 


Dr. Goldenberg
email: docgoldenberg@gmail.com
On the Web: docgoldenberg.com
Twitter: @docgoldenberg
Instagram: docgoldenberg

The Huffington Post Articles: https://www.huffingtonpost.com/author/mattgoldenberg-950


*Matthew Goldenberg D.O. is an addiction psychiatrist, board certified in General and Addiction Psychiatry and is a mental health and addiction expert. He maintains a private psychiatry practice in Santa Monica, California. 

The conditions Dr. Goldenberg treats include depression, (major depressive disorder, MDD), bipolar disorder (mania and hypomania, aka bipolar depression), anxiety disorders (such as panic disorder and panic attacks; obsessive compulsive disorder, OCD; Posttraumatic Stress Disorder, PTSD); Attention Deficit Hyperactivity Disorder, ADHD; insomnia and sleep problems; addiction (alcoholism, drug addiction aka substance abuse and substance dependence); behavioral addictions aka process addiction (food addiction, gambling addiction sex addiction etc). 

Matthew Goldenberg, D.O. Matthew Goldenberg D.O. is double Board Certified in Psychiatry and Addiction Psychiatry and is a certified Medical Review Officer (MRO). He is an expert in the evaluation and treatment of mental health disorders and is an addiction specialist for adults in his private practice in Santa Monica, California. Dr. Goldenberg also provides addiction psychiatry consultations to some of the nation’s top residential and outpatient treatment programs in the Los Angeles area and is experienced in the evaluation and treatment of professionals working in safety-sensitive positions. In addition to his clinical work, Dr. Goldenberg is an active author, researcher and invited speaker at local and national conferences. He also volunteers his time as a Clinical Instructor in the Department of Psychiatry at UCLA and is an Assistant Professor of Psychiatry at Cedars Sinai Medical Center.

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