Seeking Reimbursement From Health Insurance Companies
If you are considering using out-of-network benefits, I strongly encourage first contacting your health insurance company (you may call the phone number listed on your insurance ID card or look at the company website) and ask the following questions:
Does my plan cover services to out-of-network mental health providers?
When do my benefits start and renew?
What is the deductible I have to meet before coverage to an out-of-network provider kicks in? How much of my deductible has already been met?
Does my plan cover psychotherapy sessions with an LCSW or LICSW (Licensed Clinical Social Worker or Licensed Independent Social Worker)?
Is there a maximum amount per session the insurance will cover for an out-of-network provider?
How many sessions does my plan cover in a year for out of network services? How many sessions do I have left?
What is the process to get reimbursed for out-of-network services through a superbill?
How much time do I have to file a superbill claim for out-of-network services?
Do I need preauthorization or a referral from my PCP to see a therapist? If I need preauthorization, do I need to call or does my therapist?
Will you cover CPT code 90791 (initial assessment)?
Will you cover CPT code 90834 (45-minute individual sessions) or 90837 (60-minute individual sessions)?
Getting Reimbursed
If you have out-of-network mental health benefits, I’m happy to provide a monthly billing statement (often called a “superbill”) that you can submit to your insurance company for possible reimbursement. If you'd like to seek reimbursement, you're welcome to request a superbill at any time.
Full payment for counseling sessions is due at the time of your appointment.
A superbill is a detailed receipt I can provide each month if you're using out-of-network benefits. It includes the information your insurance company needs, like dates of sessions, the services provided, and fees charged, so you can request reimbursement directly from them.