Navigating

Out-of-Network

Out of Network

FAQs

Can I still use my insurance for out-of-network counseling?

We cannot submit claims to your insurance since we do not accept insurance at this time. But we can provide you with a super bill that you can then submit to your insurance for possible partial reimbursement. Reimbursement is dependent on your insurance policy, we encourage you to call your insurance directly to inquire about what out-of-network coverage they provide prior to beginning services.

What is a super bill?

IA superbill is a detailed document similar to an invoice or receipt, listing the services you received from your therapist. It is automatically generated by our electronic health system and sent to you monthly. For the superbill to be considered for reimbursement, it must include the following information:

  • Client name, address, and date of birth

  • Provider’s name, phone number, and email address

  • Provider's Tax ID and National Provider Identifier (NPI)

  • Statement number and date issued to the client

  • Diagnosis and CPT code

  • Service type, date, and code for reimbursement

  • The fees you paid

How can I submit a super bill?

We encourage you to reach out to your insurance provider to obtain what methods of communication they prefer to receive a super bill. But typically we have found insurance companies will accept super bills through mail, fax, or their online portal.

How do I find out my out-of-network benefits?

Call the number on the back of your health insurance card, ask to speak to a member service representative to ask questions related to what out-of-network coverage they provide. Here are some example questions that may be helpful in navigating that conversation:

  • Do I have out-of-network coverage for mental health services?

  • How much does my insurance plan reimburse for an out-of-network provider for CPT codes 90791 (initial intake session), 90834 (45 minute therapy session), and 90837 (55 minute therapy session)?

  • How do I submit a super bill?

  • What is the time limit to submit a super bill?

What are some things to consider prior to submitting a super bill to insurance?

IWhen considering your reimbursement options, it's important to remember the following:

Reimbursement requires a diagnosis. A superbill, like any other paperwork submitted for insurance reimbursement, must include a clinical diagnosis as classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

If you have any questions about your diagnosis or concerns about receiving a diagnosis, please discuss them with your therapist

How long does it take for insurance to reimburse for a super bill?

Typically, it can take your health insurance 2-4 weeks to process your superbill. They may pay a portion for the services or deny your claim. If your claim is denied we advise you to contact your insurance provider to request information about the denial.