Insurance FAQ's

Which questions should I ask my insurance company?

What is my reimbursement rate for out-of-network outpatient mental health services?" (Usually, this is a percentage, like 60% or 80%.)

"Do I have an out-of-network deductible that must be met before I can receive reimbursement?" (If so, ask how much of it you have already met this year.)

"What is the 'allowable amount' for CPT code 90837?" (This is the standard code for a 53-60 minute therapy session. Insurance companies often cap what they consider a "fair" price, and they will only reimburse a percentage of that amount, not necessarily our full fee.)

"Is there a limit on the number of sessions allowed per calendar year?"

"How do I submit my Superbills, and what is the typical turnaround time for a reimbursement check?"

What is a Superbill?

A Superbill is an itemized document used by healthcare providers that allows patients to bill their insurance company directly for reimbursement.

Unlike a standard receipt, it contains specific information—such as diagnostic codes (ICD-10), procedure codes (CPT), and provider credentials—that insurance companies require to process "out-of-network" claims.

What’s typically included on a Superbill:

• Provider Information: Name, address, NPI number, and Tax ID.

• Patient Information: Name, date of birth, and contact details.

• Service Details: Date of service, CPT code (type of session), and the fee paid.

• Clinical Info: A diagnosis code (required by insurance to justify the service).

We can auto generate these for you or provide them upon request.

What is a Good Faith Estimate?

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate.

Note: For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.