Out-of-network therapy benefits and superbills, explained

Short answer: you pay your therapist at each session, we give you a superbill each month, and you send it to your insurance company. If your plan has out-of-network mental health benefits, your insurer reimburses you directly. Here is how to find out what your plan will pay before you start.

Why some therapists are not "in network"

Neither Dr. Laird nor Dr. Shari is a contracted provider with any insurance company. That means we are "out of network" for every plan. It does not mean your insurance is useless. Many of our clients use the out-of-network benefit on their policy to cover part of the cost.

Being private-pay keeps the decisions about your care between you and your therapist. The trade-off is a little paperwork on your side, which this guide is meant to make easy.

What a superbill is

A superbill is a detailed receipt written for insurance companies. It lists the dates of your sessions, the services provided, the fees you paid, and the provider and practice information your insurer needs to process a claim. You submit it to your insurance carrier the same way you would submit any out-of-network claim, usually through the insurer's website, app or a mailed claim form.

How it works here, step by step

1. You pay at each session. We accept cash, or a check made payable to BPS (Bridgman Psychological Services). We do not accept credit cards.
2. We give you a superbill once a month. One document covers all of that month's sessions.
3. You submit it to your insurer. They review it against your policy.
4. Your insurer reimburses you directly. The check or deposit goes to you, not to us.

Five questions to ask your insurance company

Call the member services number on the back of your card and ask about outpatient mental health benefits from an out-of-network provider. Write the answers down, along with the date and the name of the person you spoke with.

1. Do I have out-of-network outpatient mental health benefits? If you have an HMO plan, the answer is usually no.
2. Do I have an out-of-network deductible, and how much of it have I met this year? Many plans pay nothing until the deductible is met.
3. After the deductible, what percentage do you reimburse? Out-of-network benefits usually reimburse at a lower rate than in-network care.
4. Do I need pre-authorization or a referral? Some plans require one before the first session.
5. How do I submit a claim, and how long does reimbursement take? Ask whether they want the superbill uploaded, faxed or mailed.

A few things that surprise people

• Couples therapy is often not covered. Many insurance companies do not pay for marital therapy, even with good out-of-network benefits.
• Coverage depends on your diagnosis and your policy. Your insurer decides what it will reimburse, not your therapist.
• Fees vary by therapist and by type of service. Your therapist will go over fees with you before you begin, so there are no surprises.

If you have questions about how this works with your plan, call the doctor you would like to see. We are glad to walk you through it.

Quick answers

Do you take insurance?

We are a private-pay practice. Neither Dr. Laird nor Dr. Shari is a contracted provider with any insurance company, but many clients use their plan's out-of-network benefit. You pay at each session and we give you a monthly superbill to submit to your insurer.

What is a superbill for therapy?

A superbill is a detailed receipt for your insurance company. It lists your session dates, the services provided and the fees you paid, so you can file an out-of-network claim and be reimbursed directly.

Can I use out-of-network benefits with an HMO?

Usually not. Out-of-network benefits are not available with HMO coverage.

Does insurance pay for couples therapy?

Often it does not. Many insurance companies do not pay for marital therapy, so check with your plan before you start.

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