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 Health 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 (an invoice/receipt we provide) 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?
• 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 that’s 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 and 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. However, your insurance plan also has an out-of-pocket maximum: $3000, which has not been reached.

Now, you have all the information 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 that 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 can spend out of pocket. Once your out-of-pocket maximum is met, your plan will be responsible for covering 100% of the allowed amount!