Journal
How out-of-network benefits and superbills work
What a superbill is, what your plan's allowed amount and deductible do to it, and the questions to ask your insurer before you start.
AI-generated illustration. Not a real office.
Out-of-network benefits are one of the least explained parts of paying for therapy, and one of the most useful. They decide whether some of what you pay a practice can come back to you. Whether any does is up to your plan, so the useful thing is to learn what to ask it.
This is what this practice does and does not do:
Out of network. We don't participate in any health insurance networks. If your plan has out-of-network mental health benefits, we can give you a monthly statement (a "superbill") to send in. Whether and how much your plan reimburses is between you and your plan; ask them before you start. If you're using out-of-network benefits, the amount we'll charge is available on request before your first session, and we'll give it to you in writing (Public Health Law § 24).
The words, in plain English
Out of network
A practice that has not joined your plan's network of contracted providers. This practice has joined none.
Out-of-network benefit
The part of a health plan, where there is one, that pays something toward sessions with a practice outside its network. Some plans have none, and some have one with conditions attached.
Superbill
A monthly statement from the practice that you send to your plan yourself. It lists the dates of your sessions, the fee for each and a procedure code for each.
Deductible
The amount you pay yourself in a plan year before the plan starts paying toward a service. If you have not reached it, a plan may pay nothing toward your first sessions, and something toward later ones.
Allowed amount
The most a plan recognizes for a service, which may be lower than the fee a practice charges. A plan that pays works from its own figure, not from the fee, so a gap between your fee and what comes back is not an error on anybody's part.
Reimbursement
Money a plan sends back to you after you have paid the practice. It comes to you, not to the practice, and it is the plan's decision.
What is on a superbill
Each session on a superbill carries a procedure code, which is how a plan knows what kind of session it was. For an individual or teenager session the code is 90834, described as psychotherapy, about 45 minutes (38 to 52). For a couples or family session it is 90847, described as family or couples psychotherapy with the client present.
You do not need to remember them. They are the answer to the question a plan will ask you: which code does your clinician use?
If you send our statement to your insurer for out-of-network reimbursement, the insurer sees the dates, the fee and the codes on it. That is your choice, and it does not waive anything else (CPLR 4508).
What a superbill cannot do
A superbill is a statement. It cannot make a plan pay, it cannot tell you what a plan will pay, and it does not mean a plan has agreed to anything. It is the paperwork you send in; what happens next is between you and your plan.
That is why nobody honestly promises you a figure, and why this practice does not. The only person who can tell you what your plan does with a superbill is somebody at the plan.
Questions to ask your plan before you start
Does my plan include out-of-network outpatient mental health benefits?
Ask in exactly those words. If the answer is no, you know before you spend anything.
Is there a deductible for them, and how much of it have I used?
Some plans keep a separate deductible for out-of-network care. Ask whether yours does, and how much of it is left.
Does the plan pay from the practice's fee or from an allowed amount, and what is that amount for these codes?
Give them 90834 for an individual session and 90847 for a couples or family session, and ask for the figure in writing or by e-mail if they will.
Is there a limit on sessions in a year, or an approval to get first?
Some plans want a form completed before sessions begin, and some do not. It is far easier to learn it now.
How do I send a superbill, and how long does it take?
An online form, a portal and a mailed form are all in use. Ask which, and how long to expect before you hear back.
Is a video session paid the same way as an in-person one?
Some plans handle them alike and some do not. Ask, because this practice offers both.
Does the plan pay for a clinical social worker out of network?
The kind of clinician can matter to a plan, so ask about this one by name.
Write down the date, the name of the person you spoke to and any reference number. If the answer you are given later differs from the one you were given on the phone, that note is what you have.
An estimate shows what you pay, never what you get back
Every session booked here comes with a written estimate in the confirmation, and one is available on request before you book. This is what one looks like for an individual first session:
What an estimate says: an individual first session
- Each session, 50 minutesCPT 90834$195
- Weekly sessions the estimate coversthe first and the next eleven12
- Estimated totalif every week goes ahead$2,340
An individual first session: $195 a session, and twelve weekly sessions would come to $2,340. That is the figure the estimate prints; you pay session by session, never in advance.
Your right to an estimate. You have the right to receive a "Good Faith Estimate" of what your care will cost if you don't have insurance or aren't using it. Ask us for one when you schedule, or any time before your session. If your bill is $400 or more above your estimate, you can dispute it. Learn more at cms.gov/nosurprises.
The estimate is about the practice's fee and what a run of sessions would come to. It contains no guess about what a plan will return, because nobody here can know it.
If cost is the obstacle
Out-of-network benefits are one way that may bring the cost down, and they are not the only one. A session here is paid at or after the session, by card, cash, check, or an HSA or FSA card, and one fee applies however you pay.
If the fee is a barrier. A limited number of reduced-fee places are available by arrangement. Ask on your free call; nobody is asked to prove anything to request one.
Fees and insurance has every fee, and insurance, said plainly says why this practice makes no promise about reimbursement.
General information, not advice for you. Nothing on this website can tell you what is going on for you. A diagnosis, where one is needed, comes from a clinician who has met you — never from a page, a quiz or a booking form.
Book a free call
Book a free fifteen-minute call, or go straight to a first session if you know what you want. Nothing is paid online, and nothing on the form asks why you're coming.