What is “out-of-network”?
Out-of-network is a group of benefits that some insurance plans include. Typically having these benefits means that a doctor does not need to be “in-network” in order for you to be able to receive at least some reimbursement from your insurance company. If you contact your insurance carrier, you should be able to be advised of whether or not your coverage includes these benefits.
Questions to potentially ask
Specifying that you are inquiring about mental health benefits for video visits, questions to potentially ask your insurance company could then be:
What is my deductible? (Amount required to be paid by you, after which the insurance company begins to reimburse you)
What percentage of the cost of the visit do you cover?
What is the maximum amount you cover for a video visit with code 90792-95 (the initial video consultation)?
What is the maximum amount you cover for a video visit with code 99214-95 (follow-up visits)?
If you are interested in seeing me for therapy as well as medication management, the codes are slightly different – please let me know and I’d be glad to go into the specifics with you.
Initial consultation: $650
Follow-up visits: $500 (up to 30 min)
Follow-up visits: $550 (up to 45 min)
Please note that the above is provided in good faith as a means of attempting to clarify what can be a very confusing situation. There are certainly many potential exclusions, loopholes, and additional complexities of which the doctor may not be aware, but hopefully the above will point you in the right direction. No responsibility is assumed on the part of Dr. Dhrymes for interaction with the insurance company or for the scenario where the actual reimbursement is not what you had anticipated. However, if you do have a question regarding any of this information, please contact Dr. Dhrymes and he will be happy to try to clarify it for you.