We are considered an out-of-network provider for those not using Blue Cross/Blue Shield for services. This means that clients will be financially responsible for the cost of treatment. However, most PPO and Open-Access plans may offer reimbursement for therapy services. For those paying out of pocket and wishing to use their out-of-network benefits, we provide a “Superbill” at the end of every month. The Superbill is a receipt of services provided and paid for that can be submitted to your insurance provider for reimbursement. The reimbursement rate depends on your individual insurance plan and its out-of-network benefits.
When checking with your provider about reimbursement, please inquire about the following:
1. Do I have out-of-network benefits for mental health therapy?
2. What is my deductible for out-of-network benefits? (The deductible is the amount you must pay before insurance begins reimbursement).
3. How much can I get reimbursed for mental health services?
Here, you want to ask a few follow-up questions:
a. Do I have a maximum amount of therapy sessions I can receive each year?
b. What is the reimbursement rate for mental health appointments?
c. What are the reimbursement percentage rates for CPT service code 90834 (Individual Therapy)
d. What are the percentage rates for a psychologist and master-level therapist (e.g., clinical social worker and professional counselor)?
Please note that HMO plans, Tricare, Medicare, and Medicaid do not reimburse for out-of-network mental health services.