Out-of-network therapy and superbills, explained

An in-network therapist has a contract with your insurance company, bills them directly and accepts their set rate. An out-of-network therapist has no such contract. You pay the session fee at the time of the session, and the therapist gives you the documentation you need to claim from your insurer yourself, if you choose to.

Some people prefer out-of-network therapy because it gives them a much wider choice of therapists.

A superbill is an itemized statement of the therapy you received. It usually includes the therapist's name, license and identifying numbers, the dates of your sessions, the type of service provided using standard billing codes, a diagnosis code, and the amount you paid. You submit it to your insurance company, usually through their website, their app or by mail, and they decide whether and how much to reimburse.

Insurance reimbursement generally requires a diagnosis on the superbill. If you would rather not have a mental health diagnosis shared with your insurer, you can simply pay privately and not submit a claim. That choice is yours.

Before you start, call the member services number on your insurance card and ask about out-of-network outpatient mental health benefits. Useful questions:

Plans vary widely. Some reimburse a large share of the fee once an out-of-network deductible is met. Others reimburse a percentage of an 'allowed amount' that is lower than the therapist's fee. Some plans, including many HMOs, have no out-of-network benefits at all. Knowing your deductible, reimbursement percentage and allowed amount lets you estimate your real cost per session.

If you have a Health Savings Account or a Flexible Spending Account, therapy is often an eligible expense. Check with your plan administrator about what documentation they need. A superbill or receipt usually works.

Under the federal No Surprises Act, if you are paying for therapy yourself or are not using insurance, you have the right to receive a Good Faith Estimate of the expected cost of your care before you begin. If the final bill is substantially higher than the estimate, you may be able to dispute it. There is more detail on my Good Faith Estimate page.

My fees are $250 for a 50-minute individual session and $325 for couples, and the first 20-minute consult is free. I am out of network and provide superbills for you to submit if you choose. The cancellation policy is 72 hours' notice to reschedule without paying in full. Full details are on the fees page.