Out of Network Benefits

Step 1: Check your benefits

Many people have OON benefits and don't even know! Verify your coverage with your health insurance provider. I recommend calling your health insurance provider and asking them:

• Do I have OON coverage?
• What are the reimbursement rates for OON mental health therapy?
• How do I submit a superbill for reimbursement?

Step 2: I provide you with a superbill

A superbill is a document that includes the following information:

• Your name
• Date of service
• My name and credentials
• Diagnosis code
• Cost of service

Step 3: You submit the superbill to your insurance for reimbursement

Many insurance companies allow you to upload a superbill through their user portal. The rate of reimbursement and time it takes to be reimbursed both depend on your specific coverage.

Step 4: You get reimbursed!

Probably the best part of this process.

1. Your privacy

In order for health insurance companies to cover mental health services, they require that providers (me) share information about you including demographic information, diagnosis, symptoms, treatment plans, and what occurred during session. Providers must provide protected health information (PHI) to insurance companies in order to defend a client's treatment.

2. Diagnosis

Insurance companies require a mental health diagnosis in order to consider providing coverage for the treatment. While diagnoses can provide insight for best practices in treatment, and can be quite validating for clients, sometimes folks don't fully meet diagnostic criteria. It's possible and common for folks to seek therapy for support with something other than a mental health disorder.

3. Administrative burden

As a friend of mine put it, there is a reason why working with insurance is a whole job position in a doctor’s office. Being in-network requires an incredible amount of time to become contracted, verify insurance policies, submit claims, pursue reimbursements or pay-outs, submit re-authorizations for treatment, and more. I choose to invest that time in my clients, gain further education, and engage in self-care in order to best show up for my clients. After all, I am just one person!

4. Services I provide

One of my passions is working with parents. If 2+ caregivers are present in the session, I would need to bill that as family therapy. Health insurance reimburses family sessions at half the rate of individual sessions, despite the clinician doing double the work. Insurance also requires a diagnosis and treatment plan for the "primary client." This means my documentation would be defending the "treatment" of one parent via diagnosis and treatment plan. This approach does not fully capture the purpose or nature of working with parents, couples, or families.

5. Coverage limits

Some insurance plans only cover a certain amount of sessions. This puts pressure on both the client and the therapist to "get it done" before the client has to either pay out of pocket or stop treatment. Healing is not linear and it's often a guess as to how long an individual will be in treament based on symptoms, current stressors, past trauma, and more.