Submitting a claim for your out of network benefits

The title of this post might not make you jump for joy. 🙂 Nonetheless, navigating the insurance process can be a pain and the goal of this post is to make it a lot less painful and help you get what you’re entitled to from your insurance company.  Mental health care is self care and self care isn’t selfish. Submitting a claim is standing up for yourself with your insurance company and getting what you’re owed.

DCNE is an out of network provider for all insurance companies and does not enter into any sort of agreements with health insurance companies, including “single case agreements.” We also do not provide insurance companies with W9s despite some of them asking for this.

Most of our clients get reimbursed a portion of what they pay DCNE but some get no reimbursement. We suggest you call your insurance company and ask about your benefits before beginning treatment. See this article for questions to ask your insurance company before you start care to know what you can expect.

The Basics:

1. For out of network health care, you will have to submit a claim.
2. Each insurance company has a different process for submitting a claim. The best way to find out is to call or go on their website. They will provide you with instructions on how to submit a claim. Hopefully it will be as easy as uploading some documents to a portal.
3. Follow those instructions as closely as possible and if something seems extreme or confusing, call them and clarify. Believe it or not, the process outlined on their sites often isn’t the only process. It is really worth calling and asking even though that might seems scary to some.
   1. One example of an extreme request is that they want your DCNE provider to sign every page of your claim. Typically, as long as you submit the correct paperwork, that isn’t necessary. Call and ask them to be sure.
4. Once you submit your claim, they have between 30-45 days (depending on your policy) to respond. If you submit anything that is incorrect, they might respond on day 45 telling you that you made a mistake in submitting your claim and asking you to resubmit, giving them another 45 days to review. It might be 3 months before you get a proper response!

The Paperwork You’ll Need:

1. DCNE will produce an invoice for the services you received. Think of this as a receipt. This is NOT what you send to your insurance company for a claim because it doesn’t have the important information they need to process the claim.
2. DCNE will produce a superbill. The superbill is what you need to submit a claim to your insurance company. The superbill has information like:
   1. The providers license number
   2. Their National Provider Identifier
   3. The procedural codes for the service you were provided. There are called CPT codes and they allow the insurance to know exactly what service you received
   4. Your diagnosis code, also known as an ICD10 code
   5. And so on
3. Whatever else your insurance company requests, which usually includes a claim form

Once you have the instructions from your insurance provider on how they’d like you to submit a claim and your DCNE superbill, you should be all set. You can always get your superbill for any services you received from DCNE on your client portal or contacting us directly.

We strongly encourage you to submit a claim, even if your deductible is high. You never know when you might need to use your insurance and having it all in order means you’re more likely to get paid what you are owed.

Remember that mental health care is self-care. Self-care is never selfish.