Using “Out-of-Network” Benefits for Therapy
Please note: While this explanation of using out of network benefits for therapy is specifically written with my own process in mind, it may be very similar to how other therapists approach it with their own clients. If you are not a client of mine, please be sure to discuss the process with your own therapist.
Before diving in, we need to define a few terms (because insurance is confusing!):
Superbill: A superbill is like an itemized receipt for therapy. It is a document that includes details of the service such as the CPT code, cost, date, diagnosis, and the therapist’s information.
CPT Code: CPT codes are used by healthcare professionals to identify the specific service or procedure billed. The most common codes I use are 90791 (for intake therapy sessions) and 90834 (for 50-minute therapy sessions).
Out-of-Network (OON): Therapists who are OON with your insurance have not signed a contract with that insurance company. That means that you pay the therapist their fee at the time of service rather than the therapist billing your insurance.
In-Network: If a therapist was in-network, you would typically pay your copay at the time of service, the therapist would bill your insurance, and the therapist would be paid by the insurance company according to their contracted rate.
With so many therapists being out-of-network, therapy-seekers may wonder… “How do I afford therapy?”
Oftentimes, therapy occurs weekly or biweekly. A typical session cost may be between $100-$200 or even higher, depending on several factors. It is understandable that anyone may struggle to see how they can fit the cost of therapy into their budget. For those who have health insurance, understanding your plan’s out-of-network (OON) benefits is one way to ease some of the stress associated with paying for therapy.
Understand Your Benefits
The first step to understanding your out-of-network benefits is to take a look at your insurance plan. You should be able to access your plan details through your insurance company’s website, your member portal or account, or by calling your insurance company (typically there is a phone number on the back of your insurance card). Some insurance plans include great OON benefits, reimbursing most of the session cost. Other plans may not provide any reimbursement. It’s important to check your specific plan to confirm your benefits.
If you would like to use the superbill path to receiving reimbursement from insurance (more details below), you’ll need to next identify how to submit a superbill. Each insurance company may have its own process for how you submit the superbill. A common process is to submit a PDF file of the superbill within your member account. If you have questions, please contact your insurance company.
Out-of-Network Process
As I mentioned above, your therapist may navigate this in a similar or slightly different way, but this is the way that I approach out of network benefits with my clients. There are two paths that you can choose from when working with me: superbill or courtesy billing. Regardless of the path you choose, please note that I cannot guarantee reimbursement. You are responsible for contacting your insurance to confirm your out-of-network benefits.
Superbill Path
Attend your therapy session.
I will charge your card on file at the rate we’ve agreed upon.
Each month, you will receive a superbill from me via your client portal. The superbill will include all sessions from that month. *This is the last part of the process that I’m a part of.
You download the superbill and submit it to your insurance according to their process, which may occur in your member account.
Reimbursements, if your plan provides them, come directly from your insurance to you.
Courtesy Billing Path
Attend your therapy session.
I will charge your card on file at the rate we’ve agreed upon.
I will then submit a claim to your insurance on your behalf. This process is called ‘courtesy billing’.
Reimbursements, if your plan provides them, come directly from your insurance to you.
Please reach out if you’d like to utilize your out-of-network benefits.
Be sure to contact your health insurance company to confirm your OON benefits, specifically for behavioral health care.
