What are out of network claims?

Out of network claims are forms submitted to your insurance provider to process possible reimbursement of medical services provided by practices that are not contracted with your insurance. Every insurance policy is different- some will cover mental health care while others may not. It is important to read your insurance provider’s policies carefully to understand what they do or do not cover.

What kinds of insurances process out of network claims?

PPO and indemnity plans might cover some portion of the cost of your initial consultation or membership fees. You’ll know if your insurance might cover some portion of your bill if you have a network of doctors to choose from rather than your insurance assigning a doctor or facility to you, with no coverage outside of that assigned doctor or facility.HMO and EPO plans will only cover the costs of doctor’s visits for one doctor or facility and therefore will not cover services through Done. You should contact your insurance company or benefits manager if you have any questions regarding your insurance.

Getting your ADHD diagnosis appointment reimbursed by your out-of-network insurance provider:

Download your Superbill:  Done makes it really easy for you to access the Superbill for your initial ADHD diagnosis assessment. All you have to do is download your Superbill from your Done patient portal.

Submit your claim: You can submit your out-of-network insurance claim online or through the mail. To submit your claim online, go to your insurance provider’s website and log in to your insurance member portal. Search for the submit a claim section of the member portal. Don’t forget to upload your Superbill pdf when you are submitting your reimbursement claim. Online submission might not be available for all carriers, if you cannot find the online option you can always contact your insurance for help.

What to expect: After your insurance provider reviews the claim, you can expect an Explanation of Benefits with a possible check in the mail 30 days after the claim is submitted. Of course, it depends on your insurance provider whether they will reimburse your appointment or not, as well as the amount that will be reimbursed. It is important to note that reimbursement requests may take several weeks and will be completed and paid out by your insurance company.