Getting Reimbursed for Therapy: Navigating Out-of-Network Insurance Benefits

In my last blog post, we talked about an overview of the pros & cons of seeing an in-network vs out-of-network therapist. We also took a deeper dive into why you might consider seeing an out-of-network therapist. This week, we will talk about the logistical steps to help you figure out your out-of-network benefits.

Step 1: Gather Your Therapist's Information

Let’s say you have found a therapist who seems like they would be a great fit for your care. You have spoken with them or looked through their website, and you know they are an out-of-network provider and are not paneled with your insurance plan. Here is some information you will want to gather from them:

1. Provider’s Full Name

2. National Provider Identification (NPI) Number 

3. Their session fees & rates

1. Optional: Get the Current Procedural Terminology (CPT) codes of the services they offer

4. Let them know you plan to receive superbills to submit for reimbursement to your insurance. 

1. Confirm if the therapist is able to provide you with superbills, or if they submit superbills on behalf of their clients.

2. If your therapist will provide you with superbills, ask how often they will be provided. Most therapists default to 1x a month, but may be able to provide them more or less frequently if you prefer.

Step 2: Contact Your Insurance

Because each insurance company and insurance plan vary so differently in benefits and coverage, you will need to contact your insurance company directly to ask questions and learn more about your coverage. Whether you contact them by phone call or by email, here are some questions you might ask to learn more about your out-of-network benefits:

1. What is my plan’s deductible? How much of my deductible have I met so far this year?

2. Does my insurance plan offer reimbursement for out-of-network mental health services? If yes, what percentage of the cost can I get reimbursed for per session?

3. Do I need a referral to see a provider out-of-network and receive reimbursement through my insurance plan?

4. If I can apply to receive reimbursement for out-of-network mental health therapy, are there any restrictions I should know about that would prevent a session from being reimbursable? 

1. For example - in-person/virtual session, session length, number of sessions, types of therapy, etc.

2. You can tell your insurance agent about the CPT codes your therapist provided you, and ask if these qualify for reimbursement.

5. How do I submit reimbursement claims for out-of-network providers? Do I email, mail, fax, or upload my superbill receipts somewhere?

6. How soon do I have to submit a superbill after a session to qualify for reimbursement?

7. How long on average will it take for me to receive my reimbursement after submitting my superbill?

If you plan to contact your insurance over the phone, I recommend having a notepad and pen on hand so you can take notes and document what they say. It can also be beneficial to get the names of any insurance agents you speak with, so it is easier to follow up on information you were provided in the future.

Step 3: After Your Session, Submitting Superbills for Reimbursement

You confirmed your out-of-network benefits and decided to move forward with seeing your new therapist. You’ve paid for your weekly appointments, and have received your first superbill from your therapist. It’s time to submit your first superbill to your insurance!

You have a few options & considerations at this point in the process. Do you plan to:

1. Submit your superbills to your insurance company yourself?
   
   If you choose option 1, make sure you have the instructions your insurance company provided you in Step 2 to properly submit a claim. It can be helpful to have a document handy with bookmarked links, fax numbers, or email addresses handy so you know where to submit your superbill for reimbursement. Make sure you fill out your claims form correctly, and be prepared to follow up with your insurance company after you’ve submitted a claim if it takes longer than you were told to anticipate.

2. Do you want to outsource this and have someone do it for you?
   
   If you choose option 2, there are companies out there that can help submit your superbills to your insurance company on your behalf. These companies may help save you a lot of time and headache, but they usually take a fee. Here are a few companies you can consider if you are looking to go with this option (note: I am not affiliated with any of these companies, I am just listing some options I have heard about for your reference!):

• Mentaya: https://www.mentaya.com/patients

• Reimbursify: https://reimbursify.com/individual-page/

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About the Author

Adora (she/her) is a licensed clinical mental health counselor associate and owner of Spring Day Therapy PLLC. In the past she has worked in various mental health settings with different age groups, populations, and levels of care. In the therapy room, Adora operates from a DBT-informed and culturally-responsive lens to support clients in working through challenges and create real-life changes. Her work is further enhanced by her passion and training in supporting Autistic individuals and providing culturally responsive care for Asian populations.

Outside the therapy room, Adora has experience working in mental health research, and is also the founder and president of FAUNA Mental Health Foundation, an Asian mental health advocacy nonprofit. She currently leads an international team of volunteers and interns to provide accessible mental health resources through their website and workshops with community partners.

Interested in receiving therapy with Spring Day Therapy? Fill out an interest form below to schedule a free 15-minute phone consultation with Adora!