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Out-of-Network Benefits and Insurance Reimbursement

We recognize that specialized assessment and support services can be cost prohibitive, and we want you to have all of the information necessary to make informed decisions about your investment with us. We hope this overview of out-of-network benefits will be helpful.

All NeuroSpark services and providers are considered out-of-network. If your health insurance plan includes out-of-network benefits and you’d like to file through your insurance, you’ll submit a superbill (this is an invoice/receipt we provide to you) for reimbursement.

You’ll need to reach out to your insurance company to get the specific info for your plan.

We recommend asking the following questions:

  • Do I have out-of-network provider benefits?

  • What is my out-of-network deductible?

  • What is my out-of-pocket maximum?

  • What is the allowed amount for …?

    • We use the following codes for assessment: 90791, 96130, 96131

      And these codes for therapy: 90834, 90847

Do I need a referral from an in-network provider to see an out-of-network provider?

Is prior authorization required?
What is the process for submitting claims for reimbursement?

So now you have the necessary information, but how does it work? Here’s an example followed by some definitions of commonly used insurance terms.

*Please note coaching services are not reimbursable through insurance plans.

Let’s say you see the amazing Dani Rodwell for a therapy session. You pay $200 out of pocket. Your insurance company may say $200 for a therapy session exceeds the allowed amount. The allowed amount for your specific plan is $150 (this is just an example- your plan may vary!).

Your out-of-network deductible is $1000, which luckily has already been reached. But your insurance plan also has an out-of-pocket maximum. Your out-of-network maximum is $3000, but it has not been reached.

Now you have all of the info you need to calculate reimbursement. Your policy pays 70%, which means you pay 30%. This is often referred to as coinsurance.

So your insurance company reimburses you 70% of $150 and that amount of $105 is processed for reimbursement for your therapy session.

If your out-of-pocket deductible had already been reached, your insurance company would have reimbursed you at 100% of the allowed amount of $150.

Common Insurance Terms

An out-of-network deductible is a set amount of money that you have to pay out of pocket before the insurance company starts to chip in. Each covered service that you pay for out-of-pocket counts towards this deductible, and once it is reached, your insurance will begin to contribute. (This often resets every year)

Co-insurance is a percentage your plan will begin to pay after you meet your deductible.

An out-of-pocket maximum is a cap, or limit, on how much you need to spend out of pocket. Once your out-of-pocket maximum is met, your plan will be responsible to cover 100% of the allowed amount!