Understanding Health Insurance Reimbursement

Interested in working with a therapist that doesn’t take your health insurance? You may qualify for reimbursement for services you pay out of your pocket. Learn what questions to ask your health insurance and explore additional resources available.

What do in-network and out-of-network providers mean?

In-network: providers have contracts with your health insurance company and can bill your health insurance directly for services.

Out-of-network: providers do not have a contract with your health insurance company, so they cannot bill your health insurance for services. You still have the option to work with an out-of-network provider, but you will have to pay for services out-of-pocket.

If your plan covers mental health services, you may qualify for reimbursement for services you pay for out-of-pocket.

Who do I contact to learn if I have out-of-network benefits?

Contact your health insurance provider directly. Their contact information can be found on your insurance card or portal. Below are questions to ask your health insurance about your out-of-network coverage and the reimbursement process.

Questions to ask your health insurance provider:

• Do I have out-of-network benefits?

• If yes, do I have to meet a deductible before you reimburse me?

• What percentage will you reimburse me?

• Are these billing codes covered:

  • Individual Therapy Billing Codes

    • 90791: Psychotherapy Intake (first session)

    • 90834: Individual Session (45 mins)

    • 90837: Individual Session (53+ mins)

  • Relationship Therapy Billing Codes

    • 90791: Psychotherapy Intake (first session)

    • 90847: Relationship/Family Session (26+ mins)

    • 90846: Relationship/Family Session, Primary Client not present

• What is the process for getting reimbursed?

• How long will it take to receive my reimbursement?
  

What is a superbill? How do I get this?

A superbill is a document you will turn in to your health insurance provider when requesting to be reimbursed. It includes all services provided that month, the cost of each service, your diagnosis, and the therapist’s information - all the information your health insurance requires to process your reimbursement.

If we work together, you will automatically receive a superbill each month. Know that some therapists don’t provide a superbill automatically, so you may need to tell them you’re interested in receiving one.

If I cannot get reimbursed, what are my options?

Slide Scale Rates:

Some therapists offer sliding scale rates, which means you would pay less than the standard rate. Some sliding scales are income-based so you may be asked about your monthly/yearly income.

Employee Assistance Programs

Some employers provide their employees with free therapy sessions as a part of their benefits package. Therapy sessions are usually limited to a certain number, generally 5-10 sessions, and will be at no cost to you.

Interns + Recent Graduates

Some therapy practices charge a lower rate or offer free therapy services if you work with a recent graduate or therapist in training.

University/College Services

If you are a college student, you may have access to free or low-cost therapy services through the health department on campus. Many providers are fully licensed therapists or graduate students of the college.

Support Groups

Therapy groups are low-cost options for therapy services. Although you will not have much 1:1 support, being in community with others who understand what you’re going through can be an incredibly empowering experience. You can search for therapy groups in your state at Therapy Den or Inclusive Therapists.

Financial support for historically marginalized communities

• The Loveland Therapy Fund provides financial assistance to Black women and girls seeking therapy services

• BIPOC Therapy Fund provides financial assistance to Black, Indigenous, and People of Color (BI&POC)

• Mental Health Fund (MHF) for Queer and Trans Black, Indigenous and People of Color (QTBIPOC)

• Lotus Therapy Fund provides financial assistance for therapy to the Asian community

Open Path Collective

Open Path Collective offers low-cost therapy services that range between $40-$70 per session. However, they require a one-time lifetime membership fee of $65.