Insurance

I am an out-of-network (ONN) provider.

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Here is what you need to know.

 

Out-of-network therapists offer flexibility, specialization, and a level of expertise that can sometimes be harder to find within a specific insurance network. If you're looking for a therapist with unique training and experience with neurodivergent issues, couples, or other specialties, an out-of-network option can often be the best fit. They may have more autonomy over their practice style and offer a more individualized approach, making it easier to tailor therapy to your specific needs.

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Insurance plans with out-of-network benefits will often reimburse part of your session cost. This allows you to choose a therapist who meets your needs, even if they’re outside your insurance network.

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How Out-of-Network Insurance Works

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When you see an out-of-network therapist, you will pay for sessions upfront and submit a claim to your insurance company for possible full or partial reimbursement. 

 

Here’s a step-by-step breakdown:

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• Verify Your Out-of-Network Benefits: Contact your insurance provider to determine if your plan covers out-of-network mental health services. Be sure to ask:

  • Does my plan have out-of-network mental health benefits?

  • What is the reimbursement rate for mental health services?

  • Is there a maximum number of reimbursable sessions?

  • Do I have a deductible for out-of-network services, and has it been met?

  • If applicable, do you cover couples therapy, CPS service code 90847?​

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• Determine the Reimbursement Rate: Out-of-network benefits often cover a percentage of the “allowed amount” after you meet your deductible. For example, if the allowed rate is $100 and your plan covers 60%, you may get reimbursed $60. Some plans also cap the number of sessions they’ll reimburse annually.

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• Pay Your Therapist Directly: Unlike in-network services, where insurance pays the provider, you’ll pay your out-of-network therapist directly at the time of each session. Save your receipts, as you’ll need these for reimbursement.

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• Submit a Superbill to Insurance: After paying for a session, ask your therapist for a superbill. This is a detailed receipt that includes everything your insurance company needs to process your claim, including the session date, provider's information, type of service, diagnosis, and billing codes. Therapy House provides Superbills monthly on the first of each month. ​

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What Is a Superbill, and How Do You Use It?

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A Superbill is an itemized receipt that’s more detailed than a typical receipt, providing your insurance company with all the necessary information to process your claim for out-of-network services. A superbill includes:

• Your therapist’s credentials, including license information

• Session fee and your payment amount

• Diagnosis and procedural codes (for insurance purposes​)

  • ​Individual Sessions are billed using CPS service code 90837, (individual psychotherapy 60 minutes)

  • Couples therapy is billed using CPS service code 90847 (Couples psychotherapy, with the patient present for 60 minutes)​​​

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This route can offer a more affordable option and access to early-career therapists who bring fresh perspectives and skills, all under the guidance of experienced supervisors. Note that the therapist can not verify or guarantee any reimbursement of coverage. ​​​

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By taking the time to understand your out-of-network benefits, you can gain more freedom in choosing the therapist who fits you best while making the most of your insurance coverage. ​​

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