Out Of Network Coverage and Superbills
Out-of-network benefits extend coverage for psychotherapy with the mental health professional of your choosing. Most insurance plans typically necessitate the patient to cover an initial deductible and subsequently reimburse a specified percentage of the fees, commonly around 75% or 80%. Some plans may impose restrictions on the number of sessions or the annual reimbursement cap. Generally, psychotherapy in an out-of-network context is not subject to management, and prior authorization is typically unnecessary.
It's important to note that our therapists do not directly engage in the claims submission process, although they will provide you with essential billing and diagnosis codes in the form of a superbill as a courtesy. This facilitates your access to entitled benefits. Understanding the extent of mental health services covered by your insurance policy is crucial. Even if you choose to handle claims independently, there is no guarantee of reimbursement for services rendered. Moreover, once an appointment is scheduled, payment for the allotted time is expected, unless you provide a 24-hour advance notice of cancellation.
We strongly encourage you to contact your insurance company and inform them of your intention to seek out-of-network behavioral health services. Consider asking them the following questions:
What is the current annual deductible?
How much of the deductible has already been met?
What is the reimbursement rate for out-of-network providers once the deductible is satisfied?
What is the process for submitting reimbursement claims?
Are there any limitations on the number of sessions or the total reimbursement amount for mental health services?
What is the coverage amount per therapy session?
How many therapy sessions are covered by my plan?
Is pre-approval required from my primary care physician?
While securing psychotherapy services through out-of-network providers may appear costlier, it presents numerous advantages. Insurance companies mandate their in-network therapists to submit regular treatment plans to maintain session authorization. This process can often lead to ambiguity and post-factum coverage determinations, which result in unexpected expenses for patients. Additionally, insurance companies frequently conduct audits on in-network psychotherapists' records, potentially undermining confidentiality.
Opting for out-of-network psychotherapy eliminates these issues that compromise the confidentiality and independence of treatment. All treatment-related decisions rest exclusively between the patient and therapist, encompassing the choice of therapy, its duration, and whether to involve external consultations or not.