Your therapist is considered an out-of-network (or self-pay, private-pay) provider for all insurance plans. This means that you are responsible for paying the full fee for each session the day of service. Because your therapist does not have a professional relationship with your insurance company, they are unable to communicate with insurance on your behalf, be it by phone, mail, fax, or email.
The partial exception to this is when it comes to “superbills.” A superbill is a document, like an invoice or receipt, that outlines the services you received with your therapist. Upon request, your therapist will provide superbills to you on a monthly basis that you can then submit to your insurance company in order to seek partial reimbursement for the therapy fees you have paid. Please note that your therapist cannot submit these documents to insurance directly — this must be done on the client’s end.
Knowing Your Out-of-Network Benefits
If you are not familiar with your out-of-network benefits for mental health, call the number on the back of your health insurance card and ask for “member services.” Be sure to ask these questions to verify out-of-network coverage:
- Do I have out-of-network coverage for mental health services (including through telehealth)?
- What is my yearly deductible? Has it been met or how much more until my deductible is met?
- How many sessions per year does my plan cover?
- How much does my insurance plan reimburse for an out-of-network provider for CPT codes 90834 and 90791? *
- What is my co-payment (if applicable)?
- Do I need prior authorization?
- Do I need approval from my primary care provider?
- How do I submit a superbill? Is there an online portal or do I have to mail or fax a copy?
- What is the time limit to submit a superbill?
* CPT codes refer to the type of service you received. CPT code 90834 refers to a typical 45-50 minute session, and CPT code 90791 refers to an initial intake assessment (first session).
Insurance companies typically have a time limit to turn in your superbill. To submit your superbill, contact your insurance company and ask for “member services” or check their website for instructions. There are usually three options for turning in a superbill: mail, fax, or through an online portal.
- Mail – you can ask your insurance for an address to mail the superbill. Make sure you allow time for delivery to stay within your limit for timely filing.
- Fax – if you would like to keep your protected health information private, we suggest not faxing from a public fax machine (such as at the library) or a work fax machine. The receipt that shows your fax was sent will include this private health information.
- Online portal – most insurance providers will have an online portal through which you can upload your superbill. It is the most secure option to send your superbill as the website will request a login or password. It is also faster than mail or fax. Be sure to ask your insurance about this option.
Insurance companies typically have a time limit in which you can submit a superbill. If you submit your superbill after this time limit, you risk losing any potential reimbursement.
It can typically take your health insurance 2-4 weeks to process your superbill. They will either pay the full amount of services minus your copay, or they will put this amount towards your deductible. If your superbill is denied, call your insurance and request information about the denial.
The superbills your therapist provides contain all the information insurance companies need to process claims for reimbursement. However, your therapist cannot guarantee that your insurance provider will process your claim or provide reimbursement. Your therapist is unable to respond to requests from insurance companies or their agents for additional information or documentation, including but not limited to tax forms, psychotherapy records, or out-of-network provider database forms.