Understanding Your Out-of-Network Benefits for Therapy
Out-of-Network benefits are the portion of costs that your insurance company will cover for services that are provided by someone who is not on their panel. These benefits can vary significantly from plan to plan (not just company to company). Not all plans offer out-of-network benefits at all. Generally speaking, HMOs do not offer out-of-network coverage while PPO and POS plans do.
The first step is to find out about your specific coverage. Call your insurance provider using the number on the back of your insurance card. If there is a number specific to “behavioral health” or “mental health”, use that one; otherwise, call the main benefits line. You’ll want to ask:
- Do I have out-of-network coverage for therapy? If so, do I have a deductible to meet before my coverage kicks in?
- What percentage of each session will be covered? Is there a maximum allowable amount?
- Is there a limit to how many sessions I can access in a year?
- Will my benefits cover online therapy or only in-person services?
Finding out about your specific coverage will help you make informed decisions about how to fit therapy into your budget.
What the $%#! is a superbill?
A superbill is essentially a very detailed receipt that provides your insurance company the information it needs to process a claim for reimbursement. The client pays the therapist for services up front, submits the superbill, and then is reimbursed directly by the insurance company.
Your superbill includes information on the dates and types of services provided, amount paid, and information about the practice and provider. It will also typically include a diagnosis, as this is usually a requirement for your coverage to kick in. Here at Stella Nova, we automatically send superbills out via our client portal on a monthly basis. Other practices may have different procedures in place, or you may need to request a superbill when you need it.
Your insurance company will have a brief form for you to complete when submitting your superbill for reimbursement electronically or via mail. Typically, you have 1-2 years to submit these (but of course the sooner you submit, the sooner you get paid!)
Pro-tip for busy folks who hate paperwork: Services like Reimbursify can take care of these submissions for you for a small fee, eliminating any headache of extra paperwork.
What if I don’t have out-of-network benefits for therapy?
Don’t despair! While your options may be more limited, you still have a variety of options for connecting with a therapist who can help.
- Use your FSA or HSA benefits: Therapy is generally a covered service that you can use your Flexible Spending Account or Health Savings Account funds to pay for.
- Find an in-network therapist: Most therapist databases offer the option to sort by insurance provider to narrow down your options. We like Therapy Den and Inclusive Therapists because of their inclusive mission statements and diverse therapists. If you’re in an area where therapists are harder to find, Psychology Today may be your best bet. You can cast a wide net as it’s the most widely used database out there.
- Ask about reduced fee and sliding scale options: Many therapists reserve a portion of their caseload for reduced fee options for people with financial need. Open Path Collective is a great resource for finding a therapist from $30-60 per session.
Your therapist should be able to help! At Stella Nova, we offer a free, 20-minute consultation for new clients. It’s a great opportunity to get all your questions about superbills and how to access out-of-network benefits for therapy answered. Most California therapists have clients who use out-of-network benefits, so we’re usually familiar with the process.
Do you have a question about therapy or mental health that you’d like a psychologist to answer? Email us at email@example.com and let us know, we’d love to answer them in a future blog post!
About the Author
Maya Borgueta, PsyD, is a clinical psychologist and founder of Stella Nova Psychology. She offers therapy in San Francisco and online throughout California. As a therapist with over 5 years experience in the private practice world, she has helped many clients access out-of-network benefits for therapy care.
Online Therapy in California
Looking for a great-fit therapist who can help you navigate life’s ups and downs? Stella Nova therapists offer mental health support online for adults and couples throughout California. We specialize in working with women and nonbinary adults, as well as couples of all genders. Our team of stellar psychologists and therapists can provide high-quality care for a range of mental health concerns. We treat anxiety, professional burnout, perinatal mental helath issues, depression, chronic pain, and more.
Schedule your free, 20-minute phone consultation to get matched with the best therapist for your goals and preferences today.