Out of Network Eligibility Step by Step Guide

how to determine if you have out-of-network coverage

Step 1. Call number on the back of your insurance card for members.

Step 2. Express that you are a potential client needing eligibility and benefits check for out of network, specifically for mental health coverage.

Step 3: Confirm your ID number, the person receiving services first and last name (if that is yourself then your first and last name), and the person receiving services Date of Birth.

Step 4: Provide the following information—

• Therapist’s first and last name (Innae Kim)

• The therapist’s NPI or Tax ID (NPI: 1174089759 & Tax ID: 33-2073608) - Billing code: 90834

Step 5: Ask the following information—

• Do I have Out of Network Benefits?

• What is my deductible?

• How much of my deductible has been met?

• What is my percentage of reimbursement?

• What is my allowable amount? (they might not disclose)

• How much can I expect to be reimbursed based on a fee of X dollars?

*Notes: For most GHI, emblem, carillon almost all $55 allowable amounts (almost all the ones with K is $55 allowable, which means you would be reimbursed $55 of the session fee)