MH² Out-of-network Insurance Guide

1. Check your out-of-network (OON) benefits

  • Call the Member Services number on your card or log in online.

  • Ask:

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

    • What is my OON deductible and how much have I met?

    • After the deductible, what percentage does the plan reimburse (coinsurance)?

    • Are telehealth visits covered? (ask for “place of service 02 or 10, modifier 95”)

    • Do I need pre-authorization or a referral?

    • How do I submit a claim (online, mail, or app)? Any special claim form?

    • What is the time limit to submit (e.g., 90–365 days from service)?

2. We will provide you with a superbill 

It includes:

  • Your name & date of birth

  • Provider name, credentials, NPI, Tax ID/EIN, address, and phone/email

  • Date(s) of service and amount charged for each visit

  • CPT code(s)

  • Diagnosis code(s)

  • Place of service

  • Amount you paid

Complete your insurer’s claim form (if required)

  • Fill in your info and the provider info exactly as shown on the superbill.

  • Choose who should be reimbursed (you or the provider).

    • If you paid out of pocket, choose you.

Submit your claim

Online: Upload the superbill (PDF/photo) and proof of payment.

By mail/fax: Include the claim form, superbill, and proof of payment.

Tip: Submit one month at a time to keep things tidy.

  • Save everything (screenshots/copies of the submission, the date, and any claim number you receive).

Watch for an Explanation of Benefits (EOB)

  • This isn’t a bill—it shows:

    • What the plan allowed

    • What went to deductible/coinsurance

    • What they’ll pay you

Receive payment

  • Payment may come by check or direct deposit.

  • Sometimes the plan pays the provider—confirm your payee preference when you submit.

If anything is missing

  • If the plan asks for more info (common), resend/upload what they need:

    • Clearer copy of superbill

    • Provider NPI/EIN

    • Diagnosis code

    • Proof of payment

    • Pre-auth note

If a claim is denied or underpaid

  1. Call and ask for the exact denial code and reason.

  2. Ask what fixes are needed.

Common fixes:

  • Missing diagnosis/CPT/modifier

  • Wrong place-of-service

  • No pre-auth

  • Telehealth not indicated

  • Provider NPI/EIN mismatch

  1. Resubmit with corrections or file a formal appeal.

    • Include superbill, notes, and any pre-auth.

    • Note the deadline (often 180 days).

Repeat monthly