Paying With Insurance:
Can I use my insurance to get reimbursed for services?
Maybe! As a Licensed Psychologist in private practice, I don’t work directly with insurance companies. Instead, I’m an out-of-network provider, which means that if your insurance policy covers out-of-network mental health services, you may be able to get partially reimbursed for our work together. Psychotherapy is often partially reimbursable, and psychological testing (or assessment) is sometimes partially reimbursable. If you have Health Savings Account (HSA), you may also be able to use funding from this account to pay for mental health services. Always ask your insurance company directly about each type of service you hope to have covered.
How does reimbursement work?
You will be responsible for payment in fulI at the end of each service provided (e.g., at the end of each therapy or testing session). At the end of each month, I’ll provide you with a superbill, which is an invoice with all the information your insurance company should need to file your out-of-network claim. You will then submit this superbill to your insurance company and wait for reimbursement, which can sometimes awhile. Please note that each insurance company has a different process for out-of-network reimbursement — it's important to contact your insurance company directly to better understand your specific out-of-network benefits for mental health services.
What information will I need to provide to my insurance company?
Typically, insurance companies need the following information in order to reimburse you: session date(s), the Current Procedural Terminology (CPT) code for the service(s) provided, and the diagnosis. All of this information is included on a superbill. I wish there was a way around having to provide a diagnosis (especially as my personal bias is that we could all benefit from therapy at times in our lives, diagnoses notwithstanding), but unfortunately, most insurance companies still adhere to a medical model and will require this information. If you’re not comfortable sharing this information with them, they may not reimburse you for services. Please note, however, that if you do choose to pursue reimbursement, the information you share with your insurance company is protected by HIPAA and is therefore still confidential information that they are not allowed to share without your permission.
How can I learn more about my specific out-of-network mental health benefits?
Call your insurance company’s Benefits Department (usually this phone number is on the back of your insurance card) and ask the questions below. Insurance can be confusing to navigate, so be sure to ask for clarification on anything you don't understand. It’s a good idea to take notes during this phone call so that you can refer to them later if you have questions or need a refresher.
Does my policy cover out-of-network Licensed Psychologists? (My license numbers are 5351 for NC clients and 0810004828 for VA clients — teletherapy only in VA).
My therapist will provide the following information on a superbill: date(s) of sessions, diagnosis, and CPT code. Is this acceptable, or will you require additional information?
Does my policy cover:
Psychotherapy Initial Intake Interview — CPT code 90791 (an initial intake session for therapy, for me OR my child)?
Individual Psychotherapy — CPT code 90834 (a 45-minute session for me OR for my child)?
Family/Couples Therapy Session — CPT code 90847 (a 45-minute session for a couple or family, including parent and child together)?
Teletherapy — CPT code 90834-95 (a 45-minute sessions over a virtual platform)?
CPT code 96130 (psychological testing/reporting by a Licensed Psychologist, first hour)?
CPT code 96131 (psychological testing/reporting by a Licensed Psychologist, each hour thereafter)?
CPT code 96136 (psychological test administration/scoring by a Licensed Psychologist, first hour)?
CPT code 96137 (psychological test administration/scoring by a Licensed Psychologist, each hour thereafter)?
Are there any mental health diagnoses that are not reimbursable?
How many sessions are covered per year?
What is my lifetime maximum for mental health benefits?
What is my deductible for out-of-network services? Has it been met?
What is the Allowed Amount for therapy fees? (This is the maximum amount your insurance company will pay toward each therapy session.)
What percentage of the Allowed Amount will be reimbursed?
What is the process for filing a claim?
Do you require my claim to be submitted within a certain number of days from the date of service in order to be considered for reimbursement? If so, what is that time period?
What is the payment schedule? (This is the amount of time it will take them to process your paperwork and reimburse you.)
What is the phone number for the Claims Department so that I can follow up on the status of my claim?
Is there a way to streamline the process of getting reimbursed?
There is an app called Better that will file your out-of-network claims for you. You can take a picture of your superbill and upload it to Better, and they will file the claim for you, keep track of receipts, and even check on whether certain services are covered for you. You can find more information here.