Guide to Super Billing:
Maximizing Your Out-of-Network Benefits
1
Why See An Out-of-Network Provider
Opting for private pay or choosing an out-of-network therapist offers greater control and flexibility in your mental health care. Here are some reasons why this option might work best for you:​
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Greater Freedom in Choosing Your Therapist: Private pay lets you choose the therapist who best meets your needs, rather than being limited to in-network options. This is particularly helpful if you’re seeking specialized expertise or services not typically covered by insurance, like couple and family therapy.
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Tailored, Unrestricted Care: Insurance often limits session length, frequency, and coverage. With private pay, you and your therapist can create a personalized treatment plan without restrictions or arbitrary limits.
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Improved Confidentiality: Insurance requires detailed treatment notes and diagnoses, which can compromise your privacy. Private pay ensures your personal information stays between you and your therapist.
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Access to Specialized Care: Many out-of-network therapists offer advanced, specialized services, such as holistic mental health care, expert couples therapy, or targeted support for burnout, giving you high-quality care not always available in-network.
2
Understanding Superbills and Reimbursement for Out-of-Network Therapy
If you choose to see an out-of-network therapist, you may still be eligible for partial reimbursement from your insurance company through a process called superbilling. A superbill is a detailed invoice your therapist provides at the end of each month.
You will pay your therapist directly for each session at the time of service. At the end of the month, your therapist will give you a superbill, which you can submit to your insurance company. Depending on your out-of-network benefits, your insurance company may reimburse you for 50-80% of the session cost. Please contact your insurance company prior to using out-of-network benefits.
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Superbilling can be a great way to blend the flexibility of private pay with the financial help of insurance. Little Blue Sky uses Mentaya - a service that submits superbills on your behalf to make getting reimbursed a headache-free process. Please inquire for more information.
3
Questions to Ask Your Insurance Provider About Out-of-Network Coverage
Before starting with an out-of-network therapist, contact your insurance company and ask these key questions to understand your coverage and potential reimbursement:
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Do I have out-of-network benefits for mental health services?
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Do these benefits cover the following codes:
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90837: Individual Psychotherapy, 53 minutes with patient
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90847: Family Psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes
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Do I have a deductible that needs to be met prior to me receiving reimbursement for out-of-network services? If yes, what is my deductible, and how much has already been met?
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After my deductible is met, how much will I be reimbursed per session? (Individual Sessions: $165, Couple & Family Sessions: $200)
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Are there limits on how many therapy sessions I can be reimbursed for each year?
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How long does it typically take to receive reimbursement once I submit a superbill?
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What is the process for submitting a superbill (e.g., online, by mail)?
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Is pre-authorization needed for out-of-network mental health services?
By asking these questions, you’ll have a clear understanding of your benefits and how to maximize them.