The best way to know is to contact your insurance company directly. You can usually find the phone number on the back of your insurance card or in your online member portal.

It’s also helpful to ask whether services must be pre-authorized to be eligible for out-of-network reimbursement.

If you prefer, Soundview’s administrative team can help explain how out-of-network billing works and what questions to ask, but your insurance company is the best source for plan-specific answers

Your Out-of-Network Insurance Checklist

When you call your insurance company, ask:

• Do I have out-of-network mental health benefits?

• Do I have an out-of-network deductible, and how much is left?

• What percentage does my plan pay for out-of-network services?

• Are sessions applied to my deductible first?

• Is pre-authorization required?

• Will reimbursement be sent to me or to the provider?

In-Network means Soundview has a contract with your insurance plan.

When a provider is in network:

• Insurance typically pays a larger portion of the cost

• Your out-of-pocket costs are usually limited to a copay, coinsurance, or deductible

• Rates are pre-negotiated between the provider and your insuranceWhat insurance plans do you accept?

Out-of-Network means Soundview does not yet have a contract with your insurance plan.

When services are out of network:

• Your insurance may still cover part of the service, depending on your plan

• Costs may be applied to your deductible before insurance pays

• Insurance may reimburse only part of the allowed amount, or may not pay at all

Any amount not paid by insurance is the client’s responsibility

Some insurance plans apply out-of-network benefits to your deductible before they begin paying.

Example:
Your session fee is $150.
Your insurance allows $120 for out-of-network services.
If your deductible has not been met, the $120 is applied to your deductible and no payment is sent at that time.

This is normal and does not mean your claim was denied. Once your deductible is met, your insurance may begin contributing toward future sessions based on your plan.

After your deductible is met, your insurance may begin paying a percentage of the allowed out-of-network amount, and you would be responsible only for any remaining coinsurance or copay required by your plan.

During Insurance Credentialing Period Soundview the following reduced self-pay rates are available:

• Individual Therapy (60 minutes): $100

• Family Therapy (60 minutes): $120

• ARNP Office Visit (30 minutes): $130

• Naturopathic Office Visit (30 minutes): $130

These temporary reduced self-pay rates are available for clients whose insurance is billed out-of-network or whose benefits are applied to a deductible during Soundview’s credentialing period.