Clinic Policies & Insurance Reimbursement

Payment is due in full at the time of service. Upon request, we provide documentation of our sessions (superbill) that can be submitted to your insurance company (typically through their online portal) to request reimbursement for out-of-network services. Most major insurance companies reimburse out-of-network services. The reimbursed amount varies based on your insurance plan. 

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To check your benefits, call the member support number on the back of your insurance card and ask the following:

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• Do I have out of network benefits?

• Do I have a deductible that I must meet before my insurance starts to cover payments?

• Is my mental health deductible part of, or separate from, my medical deductible?

• Does my policy reimburse billing codes 90792 (initial appointment), 99214 + 90833 (25 min follow up), 99214 + 90834 (50 min follow up)? 

• Where should I submit the receipt (superbill) for reimbursement?

• How many sessions are covered under my current plan per year?

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FYI & Glossary

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• Superbill:  a receipt that outlines services rendered and other information needed by the insurance company to process a reimbursement claim.

• Deductible: The amount you need to spend yearly out of pocket before OON benefits apply. You only need to meet either your individual or your family deductible to qualify for OON benefits, not both.

• Co-insurance: The portion of the visit that you pay for an OON service, after you meet your deductible. You pay either a copay or coinsurance, not both. Co-insurance is different in that it is typically a percentage of the visit cost (the portion that is not covered by your OON benefits). For example, if your insurance company offers coverage of mental health services at 80% of the allowed amount (see below), the coinsurance will be the 20% that is not covered. 

• UCR (usual customary rate) / "allowed amount": Please be aware that insurance companies set their own usual and customary rate (UCR) for mental health services based on what is typical for the geographical area. When they say that 80% of the visit cost is reimbursed, this means that 80% of the UCR is covered, not necessarily the session fee. The session fee may or may not be equivalent to the UCR. This may result in the difference between the UCR and the session fee being paid out of pocket. To avoid surprises, please consult with your insurance member support about what they expect to be covered. You can see the average UCR for your zip code at www.fairhealthconsumer.org.