Guide to Insurance for Therapy

Investing in care through Nepsis Counseling

I’m an out-of-network provider and choose to provide professional services through private-pay rather than insurance. I can provide a superbill on request for any individuals who are interested in applying for potental out-of-network reimbursement as long as you understand the implications and limitations outlined below. This means you would be responsible for paying out-of-pocket at the beginning of each therapy session with me (via credit, debit, HSA, FSA), then you’ll submit a claim for partial reimbursement with your insurance carrier (depending on your coverage, typically at the end of each month). I recommend you call your insurance agent before starting therapy so you’re fully informed of your options and financial commitment.

Using health insurance for therapy

In-Network Coverage

If your health insurance plan or EAP covers behavioral health services (e.g. psychotherapy), the insurance company will be able to give you information on in-network providers and out-of-network coverage options through your benefits package, online portal, or over the phone. It's best to start with your in-network provider list if you're looking to have all or most of your therapy costs covered through insurance.

If you qualify for a Health Savings Account (HSA) or Flexible Spending Account (FSA) through your insurance plan, you may be able to use your HSA/FSA card to pay out-of-pocket for a therapist who does not accept insurance.

Out-of-Network Reimbursement

Many well-qualified and highly-skilled therapists choose not to accept insurance due to negative experiences with insurance companies which make private practice unsustainable. Out-of-network reimbursement is one potential solution for utilizing your insurance with a therapist you want to work with but doesn't accept insurance. With this method, you will be responsible for paying the therapist's full fee out-of-pocket and later submitting a claim to your insurance company for partial reimbursement depending on your coverage.

Key steps to utilizing your out-of-network insurance benefits:

  • Check your benefits package to see what your Summary of Benefits says about your out-of-network deductible, coinsurance, and/or allowed amount for coverage.

  • Call your insurance company to verify your benefits. Confirm your out-of-network deductible, coinsurance, policies, coverage for telehealth/teletherapy, and ask for instructions on how to submit a claim form for reimbursement.

  • Ask your therapist if they can provide you with a Superbill at the end of each month. This will have a total number of sessions, diagnosis code, and total fees for services. Keep in mind that disclosing your confidential health information (e.g. diagnosis) to your insurance company may become a part of your permanent health record and has the potential to impact your premium for health or life insurance.

  • Send your Superbill directly to your insurance company for reimbursement. If you do not qualify for a mental health diagnosis or if your diagnosis is not considered billable, your insurance company may reject your claim. Depending on your plan, coverage, and if your claim is accepted, your insurance company will mail you a check to reimburse you for a portion of your costs for therapy that month.

Sliding-scale fees for out-of-network/private-pay therapists

While it's not the same as insurance coverage, some out-of-network therapists offer sliding-scale rates that are based on your income and/or financial need. These may be limited and vary based on the individual therapist and/or private practice. If you are in financial need or are underinsured, be sure to ask therapists if they offer sliding-scale options or if they have referrals to other low-cost services in your area.