Out-of-Network Benefits for Individual Therapy
Understanding superbills, reimbursement, and what to ask your insurance company.
Insurance can make an already vulnerable decision feel unnecessarily complicated. This page is here to help you understand how out-of-network reimbursement may work for individual therapy—and what to clarify before beginning.
What Is a Superbill?
A superbill is a detailed receipt that you can submit to your insurance company when working with an out-of-network therapist.
It generally includes information such as:
the date and type of service provided
the fee you paid
the appropriate billing code
your diagnosis
your therapist’s professional and practice information
If your plan includes out-of-network mental health benefits, your insurance company may reimburse you for a portion of the session fee after you submit the superbill.
Payment for sessions is still due directly to Eros & Psyche Counseling. Any reimbursement is determined and issued by your insurance company.
How Individual Therapy Coverage Works
Health insurance generally covers mental health treatment that it considers medically necessary for a diagnosed condition.
For a superbill to be eligible for reimbursement, it will typically need to include a mental health diagnosis that accurately reflects the focus of treatment. A diagnosis will only be provided when it is clinically appropriate. I do not assign a diagnosis solely to obtain insurance reimbursement.
The services provided, diagnosis, and billing code must also meet the requirements of your particular insurance plan.
Is Reimbursement Guaranteed?
No. Receiving a superbill does not guarantee that your insurance company will reimburse you.
Coverage depends on your specific plan, including:
whether you have out-of-network mental health benefits
whether your plan reimburses services provided by an associate-level clinician
your deductible and how much of it you have met
your plan’s allowed amount for the service
your coinsurance rate
whether prior authorization or a referral is required
whether telehealth services are eligible
how your plan handles the relevant billing code
Your insurance company makes the final decision about whether a claim is eligible and how much it will reimburse.
Questions to Ask Your Insurance Company
Before beginning therapy, call the member-services number on the back of your insurance card and ask:
Do I have out-of-network benefits for outpatient mental health care?
Does my plan reimburse services provided by a Licensed Mental Health Counselor Associate working under clinical supervision?
What is my out-of-network deductible, and how much of it have I already met?
Once my deductible is met, what percentage of the allowed amount will my plan reimburse?
What is your allowed amount for CPT code 90834 when provided through telehealth?
Do I need prior authorization or a referral?
Are there any limits on the number of outpatient mental health sessions my plan will cover?
How do I submit an out-of-network claim or superbill?
It can be helpful to record the date of the call, the representative’s name, and any reference number you receive.
Understanding the “Allowed Amount”
Your reimbursement may be calculated using your insurance company’s allowed amount—not the full fee you paid.
For example, if a session costs $185 but your insurer’s allowed amount is $120, any coinsurance will usually be calculated from $120.
If your plan reimburses 60% after your deductible has been met, your estimated reimbursement would be $72. You would remain responsible for the difference between the reimbursement and the full session fee.
This is only an illustration. Your actual benefits and reimbursement may be different.
How the Process Works
You pay the full session fee directly to Eros & Psyche Counseling.
I provide a superbill containing the information required for you to request possible reimbursement.
You submit the superbill through your insurance company’s member portal or claim-submission process.
Your insurer reviews the claim and determines whether reimbursement is available.
If approved, reimbursement is generally paid directly to you.
A Note About Privacy
Submitting a superbill means sharing your mental health diagnosis and treatment information with your insurance company.
Before choosing to use out-of-network benefits, you may want to consider whether you are comfortable having this information included in your insurance record.
You are not required to submit a superbill. Some clients choose to remain fully private pay even when out-of-network benefits are available.
Still Unsure?
You do not need to understand every part of your insurance plan before reaching out.
I am happy to explain the information I can provide and what the superbill process looks like within my practice. However, I cannot verify your benefits, predict reimbursement, or guarantee that your insurer will approve a claim.
Your insurance company is the best source for information about your specific plan.
Ready to Take the Next Step?
If you are considering individual therapy, a free 15-minute consultation gives us a chance to talk briefly about what brings you in and whether working together feels like a good fit.