Using Out-of-Network Benefits and Superbills

Out-of-network benefits can help with the cost of therapy. It helps to know how they work first.

If your plan is not one I am in network with, you may still be able to use out-of-network benefits. I provide superbills you can submit for possible reimbursement. Here is how that process generally works and what to ask your insurer.

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Insurance and Fees

What out-of-network benefits are

Many health plans divide providers into two groups. In-network providers have a contract with your plan and agree to its rates. Out-of-network providers do not have that contract with your specific plan. Some plans, often PPO or POS plans, still pay part of the cost when you see an out-of-network provider. Others, often HMO or EPO plans, may not pay anything outside the network except in special circumstances.

In network with most major insurance plans, including Aetna, Anthem Blue Cross Blue Shield, UnitedHealthcare and Cigna, and a participating provider in the MultiPlan network. If your plan is not one of them, out-of-network benefits may be another way to reduce your cost.

Every plan is different, so the only reliable answer comes from your insurer. Reimbursement is never guaranteed, and I cannot promise how your plan will respond.

Varies by plan
Often PPO or POS
Not guaranteed
Confirm before you start

What a superbill is

A superbill is a detailed receipt for therapy services. It typically lists the provider's name, credentials, license and identifying numbers, the dates of service, the type of service provided, standard service and diagnosis codes and the amount paid.

You submit the superbill to your insurance company, usually through its website, app or a claim form. The insurer reviews it against your out-of-network benefits and decides whether to reimburse you and how much.

Because a superbill includes a diagnosis code, it shares some clinical information with your insurer. That is true of any insurance claim for mental health care. If privacy is a concern, we can talk it through before you decide how to pay.

In this arrangement, you pay for sessions directly and then seek reimbursement from your plan. Private-pay fees are discussed before your first session.

Questions to ask your insurer

Call the member services number on the back of your insurance card and ask about outpatient mental health or behavioral health benefits with an out-of-network provider. It can help to have a pen ready and to note the date, the name of the person you spoke with and a reference number for the call.

Useful questions include: Do I have out-of-network benefits for outpatient psychotherapy? Is there a deductible for out-of-network care, and how much of it have I met this year? After the deductible, what percentage of the allowed amount does the plan reimburse? How does the plan determine the allowed amount? Is there a limit on the number of sessions? Is telehealth covered the same way as in-person care? How do I submit a superbill, and how long does reimbursement usually take?

The allowed amount is especially important. Many plans reimburse a percentage of what they consider a reasonable fee, which may be lower than what you paid. Asking about it up front helps you avoid surprises.

Deductible
Reimbursement percentage
Allowed amount
Telehealth coverage
Session limits
How to submit

How the process usually goes

First, confirm your benefits with your insurer. Next, we discuss fees during your free consultation or before your first session so you know what to expect. After sessions, I provide a superbill. You submit it to your plan, and your plan decides whether to send reimbursement to you.

Some people submit after each session. Others prefer to submit monthly. Your insurer may have its own preferences or deadlines, so it is worth asking.

If a claim is denied or reimbursed at a lower rate than you expected, your insurer should be able to explain why. Sometimes a denial reflects a missing detail rather than a lack of coverage. I am glad to help make sure the superbill itself is complete and accurate.

A note on cancellations

Appointments canceled with less than 24 hours' notice are subject to a $100 fee. Insurance plans generally do not reimburse missed or late-canceled sessions, so this fee would be your responsibility.

Clear information at the start makes the rest easier. Once practical details are settled, we can focus on the work that brought you to therapy.

Next steps

Sessions are by secure video for adults physically located in Connecticut, New York or Massachusetts. A free consultation is a good time to raise questions about cost and benefits along with what brings you to therapy. Visit the Work With Me page to request a time through the secure client portal, or read more on the Insurance and Fees page.

Common Questions

Questions People Ask

Will my insurance reimburse me if I use a superbill?

It depends entirely on your plan. Some plans reimburse part of the cost of out-of-network therapy and others do not. Please confirm your out-of-network benefits with your insurer before you begin, since reimbursement is not guaranteed.

Do you submit the superbill for me?

I provide the superbill, and you submit it to your insurer. Your plan then decides whether to reimburse you directly.

Why did my plan reimburse less than I expected?

Many plans reimburse a percentage of their own allowed amount, which can be lower than the fee paid. Your deductible also affects reimbursement. Your insurer can explain how your specific claim was calculated.