Using Out-of-Network Benefits

An in-network therapist has a contract with your insurance company and bills it directly. An out-of-network therapist does not — you pay the session fee yourself, and then, if your plan includes out-of-network benefits, you submit a claim for partial reimbursement.

Many PPO plans include these benefits; HMO plans generally do not. It is worth a phone call to find out which you have before assuming therapy is or is not affordable.

A superbill is simply a detailed receipt for therapy — the document your insurer needs to process an out-of-network claim. It includes the dates of sessions, the codes they require, and my license information. You submit it, and any reimbursement your plan allows comes directly to you.

To make this easier, I work with a company that streamlines out-of-network claim submission and reimbursement, so the paperwork does not become a second job.

When you call your insurer, ask: Do I have out-of-network mental health benefits? What is my out-of-network deductible, and how much of it have I met? What percentage of the fee is reimbursed after that? Those three answers tell you most of what you need.

The honest limits: reimbursement is rarely the full fee, deductibles apply, and some plans cover nothing out of network. I also offer a sliding scale for eligible clients, so if cost is the barrier, please say so. Fees are payable by Zelle or credit card through a secure client portal, with autopay available.