Unlocking Reimbursements: Navigating Therapy Sessions with Non-Insurance Therapists
Learning about one’s health insurance can feel daunting and overwhelming—but it shouldn’t be! It is really empowering to learn the in’s and out’s of one’s insurance plan and receive reimbursement and coverage for your doctor appointments and visits. In this article, I will teach you the in’s and out’s of receiving reimbursements for your therapy sessions with the therapist that does not take insurance.
Many, but not all Health Insurance plans cover Psychotherapy services and many but not all all psychotherapists accept insurance. This disconnect can be remedied through the Superbill- a medical receipt that the client submits to their insurance for possible reimbursement… I will get into this more below.
Oftentimes individuals begin their search for a Psychologist through their insurance company’s website. Unfortunately, it is more often than not that many of my friends, colleagues or new clients tell me challenging stories about how hard it is for them to find a therapist that is in-network with their insurance and currently accepting new patients. However, if you have found a Psychologist who is in network with your insurance that is fantastic! Your provider will provide you with information regarding billing and insurance coverage.
If you are unable to find a Psychologist who is in-network with your insurance or you are already seeing a Psychologist and paying out of pocket for your sessions, there is a chance that you can receive reimbursement for your sessions retroactively through your health insurance.
How can I get my insurance to cover my therapy session with my Psychologist who doesn’t accept insurance?
Each insurance plan is different, but yours may reimburse you for some or all of the cost of your psychotherapy sessions. First, I would recommend you familiarizing yourself with your health insurance plan. Give your insurance company a call or do a deep dive online in order to familiarize yourself with your plan. Find out if your health insurance plan will reimburse an Out of Network Provider (the Psychologist/Counselor you see who does not accept insurance is out of network). Maybe your plan covers 50% of the session or even 80% of the session cost, it is a case by case basis. As soon as you figure out how much your insurance will reimburse the cost per service, have a conversation with your Psychologist or the one you have been wanting to reach out to regarding their policy on Superbills and if they incorporate them in their practice.
Check your benefits online:
https://calculator.meetnirvana.com/
What is a Superbill?
A Superbill is a receipt of services from an out-of-network provider that the client submits to their health insurance. The Superbill reflects the dates of service, the service code, the diagnosis code, the fee per service in addition to the credentials of the individual provider.
How do I Submit a Superbill?
Each insurance company works a bit differently. It is best to call your insurance company to obtain your plan benefits. Ideally the call will take between 15-20 minutes and provide the opportunity for you to familiarize yourself with your benefits and learn how to submit a Superbill. On this call, make sure. to ask the representative, “What are my out-of-network healthcare benefits for behavioral health in an out-patient setting?”
Make sure to take notes to the answers and ask clarifying questions.
Some more questions to ask. on this call:
Is pre-authorization required? If it is, ask the representative to get this started on the call.
How does my co-pay get effected? (if applicable)
Do I have a deductible and how does it get effected through out of network claims? (if applicable)
To make sure your submission will be accepted:
Verify your out-of-network benefits
Verify how to submit a Superbill (have a point of contact at your insurance company)
ex: Mail, Fax, Email, upload through Insurance company online portal
Confirm your home address with your health insurance (especially if a check will be issued)
What Can I Expect After Submitting My Superbill?
When a claim has been received by insurance, most insurance companies will make a determination on reimbursement in two weeks to a month. However, each insurance company works differently and some may take longer than others to reimburse out of network claims.
If you have yet to receive payment and some time has passed, give your insurance company a call and ask, “What is the status of the claim submitted?” On this call, the insurance representative will inform you of the status of the claim— denied, in process or completed.
Once the claim has been processed you may receive a check in the mail or through a direct deposit into your account for the percentage of the fee per service your plan covered.
I hope this article was helpful in providing you the information and tools to receive affordable and accessible mental health services!
Ready to get started? Our team at the Brentwood Therapy Collective is currently accepting new clients in-person in Los Angeles or virtually across the state of California.
