Out-of-Network Benefits and Superbills
If our practice is not in network with your plan, a superbill may help you seek reimbursement. Here is how it generally works and what to ask your insurer.
01
What out-of-network means
Being in network means a therapist has a contract with your insurance company. Out of network means there is no contract. Many plans, especially PPO plans, still include out-of-network mental health benefits. In that case you pay the practice for each session, and then you may be able to ask your insurer to reimburse part of the cost. Whether that is possible, and how much, depends entirely on your plan. Checking first saves surprises later.
02
What a superbill is
A superbill is a detailed receipt for therapy services. It typically lists the provider's information, the dates of service, the type of session, and the diagnosis and service codes an insurer asks for. Our practice can provide superbills. You submit the superbill to your insurance company, often through an online portal or by mail. The insurer then decides whether and how much to reimburse you, according to your plan. Keep copies of everything you submit.
03
Questions to ask your insurer
Call the number on your insurance card and ask about outpatient mental health benefits from out-of-network providers. Useful questions include: Do I have out-of-network benefits for outpatient therapy? What is my deductible and how much have I met? What percentage is reimbursed after that? Is there a limit on the number of sessions? Do I need preauthorization? Are telehealth sessions covered the same way? How do I submit a claim? Write down the date and the name of who you spoke with.
04
Understanding what you will pay
You pay the session fee up front. Intake / assessment session: $220. Ongoing sessions (55 minutes): $160. Reimbursement can take weeks and may be applied to your deductible first, so you might not receive money back right away. Some people find out-of-network care workable and others do not. Sliding scale is available for those who qualify. Ask us about our sliding scale when you reach out. Ask questions until the numbers make sense to you.
05
A note about privacy
Submitting a superbill means a diagnosis code is shared with your insurer, just as it would be for in-network care. Some people choose to pay privately without submitting claims for that reason. There is no single right choice. If you have questions about how a diagnosis appears on paperwork, ask during a consultation, and remember that the practice confirms details with you before anything is submitted on your behalf. Either choice is yours to make.
Questions
Before You Begin
Do you guarantee reimbursement?
No. Reimbursement is decided by your insurance company based on your plan.
Do you submit the superbill for me?
Typically you submit it to your insurer. Ask during a consultation how superbills are provided.
Is a sliding scale available?
Sliding scale is available for those who qualify. Ask us about our sliding scale when you reach out.
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