Navigating Insurance

We understand that navigating your health insurance coverage can be tricky. Here are key questions you can ask your health insurance provider to get clarity:

1. Coverage for Therapy:

   Does my plan cover therapy services (mental health or behavioral health)?

2. Deductibles, Copays, and Coinsurance:

   What is my deductible for mental health services?

   What is the copay or coinsurance for each therapy session?

   How many therapy sessions are covered per year?

3. Prior Authorization and Referral Requirements:

   Do I need prior authorization or a referral to see a therapist?

   How do I get authorization or a referral, if needed?

4. Telehealth Services:

   Are teletherapy or online therapy sessions covered under my plan?

   Are there any restrictions or differences in coverage for telehealth services?

5. Out-of-Pocket Maximums:

   What is the out-of-pocket maximum for mental health services?

   Once I meet this maximum, are therapy sessions fully covered?

6. Diagnosis Requirement:

   Does my insurance require a formal diagnosis for therapy coverage?

7. Out-of-Network Providers:

   Does my plan cover out-of-network providers?

   What is the reimbursement rate for out-of-network services?

   How do I submit a claim for out-of-network therapy?

8. Superbills and Reimbursement:

   How can I submit a superbill for out-of-network therapy services for reimbursement?

   What information is required on the superbill for processing?

9. Session Limits and Treatment Duration:

   Is there a limit to how many therapy sessions I can have?

   How is the length of treatment or therapy decided?

10. Specialized Services:

    Does my plan cover specialized therapy services such as EMDR, trauma therapy, or group therapy?

What Are Superbills and How Can They Help You with Out-of-Network Therapy?

Many insurance plans offer out-of-network benefits that allow you to recoup some of your therapy costs paid out of pocket. At Embracing Wellness LLC, we provide superbills to keep therapy accessible and help our clients navigate their out-of-network benefits.

What Is a Superbill?

A superbill is a detailed invoice provided by your therapist that outlines the services you’ve received. It’s different from a regular bill because it contains specific medical codes and information that your insurance company needs to process an out-of-network reimbursement claim. Think of it as a receipt you can submit to your insurance provider to potentially get reimbursed for the therapy services you paid for upfront.

What Information Does a Superbill Include?

• Client Information: Your name, date of birth, and contact information.

• Therapist Information: Your therapist’s name, credentials, National Provider Identifier (NPI), and contact information.

• Date of Service: The date(s) you had your therapy session(s).

• CPT Code: A Current Procedural Terminology code, which represents the type of therapy service provided

• Diagnosis Code: A code representing the diagnosis your therapist is treating, if applicable (many insurance companies require this)

• Fee: The total amount you paid for each session.

• Payment Status: Whether the amount is paid in full or if there is an outstanding balance.

How Does a Superbill Work?

1. Pay for Your Session: With out-of-network therapy, you typically pay the full session fee directly to your therapist at the time of the service.

2. Receive the Superbill: Your therapist will provide you with a superbill that contains all the information mentioned above.

3. Submit to Insurance: Once you have the superbill, you submit it to your insurance company (usually via their online portal, mail, or email) as part of a claim for out-of-network reimbursement.

4. Get Reimbursed: If your insurance plan includes out-of-network coverage, they will review the superbill and potentially reimburse you for a portion of the therapy costs, based on your plan’s policies (deductibles, coinsurance, etc.).

Will My Insurance Reimburse Me for Therapy?

Every insurance plan is different, so it’s important to check your out-of-network benefits before starting therapy.

Key questions to ask your insurance provider include:

• Do I have out-of-network benefits for mental health services?

• What percentage of the session fee will I be reimbursed?

• Is there a deductible I need to meet before I can receive reimbursement?

• Are there any limits on the number of therapy sessions per year?

• Once I mail in a receipt, when can I expect to receive a reimbursement check?

• Is pre-approval or pre-certification of sessions required? Who must obtain the pre-approval or pre-certification? (Client, therapist, either)

Why Would I Use a Superbill?

Using a superbill allows you to work with a therapist who isn’t in your insurance network but is a good fit for your needs. This can be especially important if:

• You want to see a therapist with specialized expertise (e.g., trauma-informed care, racial trauma).

• You value privacy and don’t want to involve insurance directly in your mental health care.

• Your insurance network has limited options, and you prefer more flexibility in choosing your provider.

Things to Keep in Mind

• While superbills can help with reimbursement, the process may take some time, and insurance companies may not always reimburse the full amount. It’s also important to remember that you are responsible for paying your therapist upfront, and any reimbursement from your insurance provider will come later.

• Superbills offer a way to reduce out-of-pocket costs for therapy when your therapist isn’t in-network. By being informed about how your insurance works and utilizing superbills, you can take advantage of your out-of-network benefits to receive the care that best fits your needs.

  If you have any questions about how this process works, feel free to reach out.