Using Out-of-Network Benefits for Mental Health Treatment
Many PPO plans pay for treatment with providers outside their network. Here is how out-of-network coverage works, and what admissions checks with your plan for you.
Two ways your plan can pay for treatment
Wings works with many PPO plans, often through their out-of-network benefits. Here is the difference.
You have
A PPO plan
In‑network providers
- What it means: The provider has a contract with your plan.
- What you pay: Usually less, after your in-network deductible.
- Which plans: All plan types, within their network.
Out‑of‑network providers
Wings, often- What it means: The provider has no contract with your plan, and your plan still pays a share.
- What you pay: Usually more, after a separate out-of-network deductible.
- Which plans: Most PPO plans. HMO and EPO plans usually do not.
Whether your plan treats Wings as in-network or out-of-network depends on the plan. Admissions checks it for you, free.
What decides how much your plan pays
These words show up on every benefits call. You do not need to work them out yourself, but it helps to know them.
- Deductible
- What you pay each year before your plan starts paying. Out-of-network care often has its own deductible.
- Coinsurance
- Your share of the cost after the deductible, as a percentage. Your plan pays the rest of the allowed amount.
- Out-of-pocket maximum
- The most you pay in a plan year. After you reach it, your plan pays covered care in full.
- Allowed amount
- What your plan decides a service is worth. Your share is based on it.
- Authorization
- Approval your plan may need before residential, PHP or IOP starts, and again as treatment continues.
- Medical necessity
- Your plan’s criteria for a level of care. The clinical assessment documents it.
One call to your plan, so you do not have to make it
- Whether your plan has out-of-network mental health benefits
- Your deductible, and how much of it is already met
- Your coinsurance and out-of-pocket maximum
- Whether residential, PHP or IOP needs an authorization
- What your plan needs to see for medical necessity
- What you may owe, explained plainly before you start
No surprises about out-of-network costs
With out-of-network care, part of the cost may be yours until you reach your deductible and out-of-pocket maximum. Before you start, admissions explains how billing works with your plan, what your plan is expected to pay, and anything due at admission.
Questions about your plan?
Admissions answers calls 9 a.m.–5 p.m., seven days a week.
Call(760) 388-6369If your plan has no out-of-network benefits
If your plan does not cover out-of-network care, admissions can talk through the other options.
HMO, EPO or no network option
Single case agreements
When your plan has no in-network program for your needs, it may agree to cover Wings for your case.
Learn more
Without insurance
Private pay
What drives the cost of treatment, and what admissions can explain about paying privately.
Learn more
Not accepted
Medi-Cal and Medicare
If you have Medi-Cal or Medicare, admissions can point you to programs that accept it. If you also have a private plan, admissions can check that too.
Wings works with many PPO insurance plans
Admissions verifies your benefits before admission, free and confidential. For Medi-Cal or Medicare, admissions can point you to programs that accept them.
Questions about out-of-network benefits
In-network or not, HMO plans, what you will pay, authorizations and other options.
Don't see your question?
Admissions answers calls 9 a.m.–5 p.m., seven days a week. Calls are confidential.
Call(760) 388-6369Visits, phones, what to bring and more in the admissions FAQ →All the ways to reach Wings →Is Wings in-network with my insurance?
Wings works with many PPO plans, often through out-of-network benefits. Whether your plan treats Wings as in-network or out-of-network depends on the plan. Admissions checks it for you, free.
How do I know if my plan has out-of-network benefits?
Admissions checks for you, free and confidential. Most PPO plans include them; HMO and EPO plans usually do not.
My plan is an HMO or EPO. Can I use out-of-network benefits?
HMO and EPO plans usually do not cover out-of-network care. In some cases a single case agreement is possible. Admissions checks your plan and tells you plainly.
How much will I pay?
It depends on your deductible, coinsurance and out-of-pocket maximum. Admissions checks your benefits and explains what you may owe before you start.
Does my plan need to approve treatment first?
Many plans require an authorization for residential, PHP or IOP, and review it as treatment continues. Admissions handles the authorization request with your plan.
What if my plan has no out-of-network benefits?
Admissions can look at a single case agreement with your plan, or explain private pay. If you have Medi-Cal or Medicare, admissions can point you to programs that accept them.