How to check your coverage

Written By Leslie Moore

If you’ve noticed that I am an out-of-network provider, you might be wondering what that actually means for you financially. The good news is that many clients, especially those with PPO insurance plans often receive reimbursement for therapy. Even if you have an HMO plan, or want to use a Health Savings Account (HSA) or Flexible Spending Account (FSA) card, there are ways to make therapy accessible and potentially reimbursable.

Here’s a simple guide to help you understand how it works and how to check your benefits.

Step 1: Call the Member Services Number on Your Insurance Card

On the back of your insurance card, you’ll usually see a Member Services phone number. Call that number and let them know you’re seeking outpatient mental health therapy with an out-of-network licensed therapist. Ask them the following questions…

You can read these off to the representative:

  • Do I have out-of-network benefits for outpatient mental health therapy, and what is my deductible and reimbursement rate?

  • Are there any limits on how many therapy sessions are covered per year?

  • My therapist provides monthly superbills—how and where should I submit them for out-of-network reimbursement, and is there anything else required on my end to make sure I am covered?

Understanding Deductibles and Payment Options

Many people are surprised that even “in-network” therapy may require meeting a deductible before insurance coverage begins. Sometimes, the difference between in-network costs once your deductible is met is similar to what out-of-network costs end up being.

Out-of-network therapy can also be paid with an HSA or FSA card, giving you flexibility and potential tax advantages while still accessing specialized care. HMO clients may also be eligible for partial reimbursement with a referral.

What Is a Superbill?

A superbill is a detailed receipt for therapy services that includes all the information your insurance company needs to process reimbursement.

I provide superbills at the end of each month. You simply submit the superbill to your insurance company (often through their online portal), and they reimburse you based on your out-of-network benefits.

Why Some Clients Prefer Private Pay:

  • Greater privacy (sometimes no diagnosis required for reimbursement)

  • More flexibility in treatment approach

  • Access to specialized care (adjustment, life transition, relationship, performance-focused therapies, etc.)

  • No session limits dictated by insurance

  • Ability to focus on quality of care rather than insurance restrictions

Specialized therapy can be a meaningful investment, and I understand that it’s not always feasible for everyone. For many clients, the insight, coping skills, and relief they gain feel worthwhile over time.

Leslie Moore