What’s out-of-network insurance coverage?
Many medical insurance plans provide special coverage when you use their network of participating providers, called in-network providers. A provider who isn’t in-network is considered an out-of-network provider.
Your insurance plan may cover out-of-network provider services for both the medical (Journey Clinical Clinician) and psychotherapy components of treatment. If so, your KAP Treatment may be eligible for partial reimbursement.
How do I know if I get out-of-network insurance coverage?
Call the phone number on the back of your medical insurance card, and ask if your plan offers out-of-network insurance coverage. Here are the codes you can ask your insurance company about:
- Intake consultation: 99204
- Follow-up consultation: 99214
- Therapy session: 90837
Alternatively, you can request a free insurance benefits check here.
How much will my insurance cover?
Out-of-network insurance coverage rates vary between medical insurance plans. Many plans will cover up to 80% of an eligible out-of-network service.
Keep in mind:
- If you have a deductible, an amount that you’re responsible to pay out-of-pocket before insurance coverage kicks in, you’ll need to meet that amount first.
- Your medical insurance company covers eligible expenses by reimbursing you, so you’ll pay at time of service and then submit a claim for reimbursement.
What’s a deductible?
A deductible is the amount that you’re responsible to pay out-of-pocket every year before insurance will begin to cover some types of care, such as out-of-network services.
Example:
Your insurance plan offers 70% out-of-network coverage with a $1,000 deductible. Here, you pay the full amount for your services out-of-pocket until you reach $1,000 in payments for the year. After that, you continue to pay out-of-pocket, but now your insurance company reimburses you for 70% of those out-of-network payments.
Keep in mind:
- Your deductible amount restarts every calendar year.
- To get reimbursed for out-of-network expenses, you must submit a claim to your insurance company after the service. This claim includes information about the type and cost of the service. A superbill is a document that includes the required information, and we create it for you.
What’s a superbill and how do I get one?
A superbill is a document that your medical insurance company requires when you submit a reimbursement claim for out-of-network expenses. The provider—in this case, Journey Clinical or your therapist—documents your diagnosis, and the date, type, and payment amount of services provided. For psychotherapy, you’ll submit a separate superbill from your therapist.
How to get your superbill from Journey Clinical for your Medical Consultation
- Log in to your Patient Portal. On your Dashboard, under Past Appointments, select ‘Submit a claim’.
- From the next page, select ‘Download superbill’ and save it to your chosen location.
- Optional: On the same page, you can select ‘Submit a claim’ to request reimbursement through our secure partner, Thrizer. Thrizer takes care of everything that you would do for reimbursement through your medical insurance company.
Note: Superbills through Journey Clinical are for Clinician Visits only. To get a superbill for your psychotherapy visits, read Can I also get a superbill for my therapy visits?
Why does my superbill show a different payment amount?
When you pay for your Medical Consultation, you pay for the Clinician Visit and for the ketamine medication, with shipping. The Clinician Visit may be eligible for out-of-network reimbursement, and you will see that amount listed on the superbill. Ketamine medication is not eligible for reimbursement, so that cost isn’t listed on the superbill.
Can I also get a superbill and reimbursement for my therapy visits?
Many insurance companies cover traditional talk therapy, which is the modality used for KAP Preparation and Integration sessions. Please note that your therapist will determine how much (if any) of your dosing session is eligible for insurance benefits. If any amount, typically only the first hour of dosing sessions will be covered by insurance (for in-network coverage) or eligible for reimbursement (for out-of-network coverage). Dosing sessions typically take 2-3 hours.
Even if your out-of-network therapist doesn’t take insurance, you can ask your out-of-network therapist for a superbill that itemizes each visit you’ve had. Many therapists prefer to give clients a superbill at the end of each month, but you can coordinate with your therapist to get the superbills when you need them.
If your therapist needs help creating a superbill, they can reach out to our Membership Support Team at support@journey.clinic.
Once you get the superbill from your therapist, follow the process outlined in How do I submit a reimbursement claim with my superbill?
How do I submit a reimbursement claim with my superbill?
How to submit a reimbursement claim:
- For medical services: First, you can download the superbill PDF from your Patient Portal. Then you submit a reimbursement claim to your medical insurance company with the superbill PDF attached.
- For psychotherapy: First, you can ask your therapist to provide a superbill PDF. Then you submit a reimbursement claim to your medical insurance company with the superbill PDF attached.
Two ways to submit a reimbursement claim:
- Directly to your medical insurance company using their established process.
- Through your Journey Clinical Patient Portal using our partner platform, Thrizer.
What’s Thrizer?
Thrizer is an online platform that Journey Clinical partners with to simplify the insurance reimbursement claim process. Thrizer helps you get reimbursed by connecting to your medical insurance company and automatically tracking your deductible and coverage. It routes your reimbursement to your bank of choice, and even follows up on claim denials to make sure that you get the full reimbursement your insurance company owes you. Note: Thrizer charges $1.50/claim submission + 1% of the reimbursed amount upon receiving the reimbursement.
How to submit a reimbursement claim:
- From your Patient Portal, select ‘Submit a claim with Thrizer’
- Add your insurance information
- Add a payment method (for the $1.50/claim fee + 1% of the reimbursed amount)
- Link a bank account where you want your reimbursement to be sent
Thrizer also has an option for you to request instant reimbursement if you don’t want to wait for the medical insurance company to approve your claim. Learn more here.
Is Thrizer free?
No, Thrizer charges $1.50/claim + 1% of the reimbursed amount upon receiving the reimbursement. Journey Clinical does not take any fee from this. The benefit of using Thrizer instead of your medical insurance portal is that it’s easier to use, all in one place, and offers support for claim denials and appeals.
Still have questions about out-of-network insurance coverage? Want to talk to someone in person? Book a free 20 minute welcome call with our Care Team.