How Out-of-Network Coverage Can Make Testing More Accessible

We understand that paying upfront for psychological testing can feel overwhelming, especially when you're unsure how much your insurance will reimburse. Many people believe that out-of-network (OON) providers offer no coverage, while in-network means full coverage.

This is a common misconception—and it’s usually not true!

Here’s what you need to know about out-of-network coverage and how it compares to in-network care.

In-Network vs. Out-of-Network: What’s the Difference?

It’s tempting to think that in-network means full coverage and out-of-network means no reimbursement, but that’s rarely the case.

• In-Network Care: Insurance plans have pre-negotiated rates with in-network providers. While this often means lower costs, you’re still responsible for co-pays, coinsurance, your deductible, and any non-covered services.

• Out-of-Network Care: As an OON provider, we don’t have pre-negotiated rates, but many insurance plans still offer reimbursement for out-of-network services, sometimes covering a substantial portion of the fee.

In fact, about 70-80% of insurance plans offer reimbursement for out-of-network care, especially for psychological testing services.

How Much Will Insurance Cover?

While there isn’t a single answer due to the variability in insurance plans, several key factors will determine how much your insurance is likely to reimburse.

• Your Plan’s Out-of-Network Coverage: Some plans reimburse OON care at rates close to in-network rates, while others offer less. We can help you understand your specific plan’s details.

• Deductibles and Out-of-Pocket Costs: Whether in-network or out-of-network, your deductible plays a key role. If your deductible isn’t met, you’ll pay more upfront for either type of care. However, for psychological testing, out-of-pocket costs can sometimes be similar between in-network and OON care.

• Psychological Testing Reimbursement Rates: Many insurance plans offer higher reimbursement rates for testing services compared to other types of mental health care, often between 50% and 80% of the total fee.

How Does This Work in Practice? A Hypothetical Example

Let’s walk through a simple example to show how out-of-network and in-network coverage can compare:

Imagine you’re considering a psychological testing service that costs $2,500. Your insurance plan has an in-network coinsurance rate of 80% (meaning the insurance covers 80% of the allowed amount after your deductible is met) and an out-of-network coinsurance rate of 60%. Your deductible is $1,000, and you’ve already met $500 of it.

Here’s how the costs would break down:

In-Network:

• Total cost of testing: $2,500

• Remaining deductible: $500 (You’d need to pay this first)

• Insurance covers 80% of the remaining amount: After the deductible, the remaining balance is $2,000. Your insurance covers 80% of this, or $1,600.

• Your responsibility: $500 (deductible) + $400 (your 20% coinsurance) = $900 out-of-pocket

Out-of-Network:

• Total cost of testing: $2,500

• Remaining deductible: $500 (You’d need to pay this first)

• Insurance covers 60% of the remaining amount: After the deductible, the remaining balance is $2,000. Your insurance covers 60% of this, or $1,200.

• Your responsibility: $500 (deductible) + $800 (your 40% coinsurance) = $1,300 out-of-pocket

The Difference: In this example, the out-of-network service would cost you $1,300 out-of-pocket compared to $900 for in-network, a difference of $400. Given that out-of-network psychological testing often offers shorter wait times, more personalized care, and fewer insurance restrictions, this relatively small difference in cost may be well worth it for the added benefits.

Our Complimentary Out-of-Network Benefit Check Service

To help you understand your benefits and potential reimbursement, we offer a complimentary OON benefit check. Here’s how it works:

1. Contact Us: Let us know you’re interested, and we’ll send a secure link to upload your insurance details.

2. We Check Your Benefits: We’ll verify your coverage through our secure online system.

3. Receive a Summary: You’ll get a brief report outlining your deductible, coinsurance rate, and a general estimate of your reimbursement potential.

4. Optional Detailed Estimate: If desired, we’ll provide a script to help you contact your insurance for more specific information, including pre-authorization and claim submission details.

Additional Benefits of Out-of-Network Care

In addition to potential reimbursement, choosing OON care offers several advantages:

• More Control Over Your Treatment: Decisions about your care are made between you and your psychologist, without insurance company interference.

• Shorter Waitlists: We can often offer faster appointments compared to many in-network providers.

How We Can Help with Reimbursement

We aim to make the reimbursement process as smooth as possible. Here’s how we assist: 

• Superbills: After your evaluation, we’ll provide a superbill with all necessary information for your insurance claim.

• Pre-Authorization Support: If required, we’ll help you navigate the pre-authorization process.

• Claim Submission Guidance: We can guide you on how to submit your superbill and answer any questions your insurance may have.

Want More Information?

If you’d like more specific details from your insurance provider, here are some key questions to ask:

• “Do you offer Out-of-Network benefits for psychological testing, such as CPT Codes: 90791, 96136, 96137, 96130, 96131, 90837?”

• “What percentage of the cost is covered for Out-of-Network providers?”

• “What is my Out-of-Network deductible, and how much has been met?”

• “Is pre-authorization required for psychological testing?”

• “How do I submit an Out-of-Network claim?”

We can also gather this information on your behalf if you prefer.

Let’s Work Together

We’re here to support you through every step of the process. If you have any questions or need assistance with verifying your benefits or submitting a claim, please contact us. Our goal is to reduce your financial stress and make this process as transparent and clear as possible—so you can get the care you need, when you need it.