Guide To Superbilling
Project Passion Therapy is not in network with any insurance companies. I understand that the use of insurance makes therapy more accessible for many but it often creates more problems than it solves. To better understand the reasons behind this decision please see “Do you take insurance?” on the FAQ
Maximize Your Out-of-Network Benefits
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Why should I see an OON provider?
Greater Freedom in Choosing Your Therapist: Private pay lets you choose the therapist who best meets your needs, rather than being limited to in-network options. This is particularly helpful if you’re seeking specialized expertise or services not typically covered by insurance, like sex therapy or partnered therapy.
Tailored, Unrestricted Care: Insurance often limits session length, frequency, and coverage. With private pay, you and your therapist can create a custom plan without restrictions or arbitrary limits.
Improved Confidentiality: Insurance requires detailed treatment notes and diagnoses, which can compromise your privacy. As I see many folks from marginalized groups the expectation to document identities is not aligned with protections I want to offer. Private pay ensures your personal information stays between you and your therapist.
Access to Specialized Care: Many out-of-network therapists offer advanced, specialized services, such as holistic mental health care, expert couples therapy, or targeted support for sex therapy, giving you high-quality care not always available in-network.
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Understanding Reimbursement
If you choose to see an out-of-network therapist, you may still be eligible for partial reimbursement from your insurance company through a process called superbilling. A superbill is a detailed invoice your therapist provides at the end of each month. Project Passion is happy to provide superbills for all services rendered.
You will pay your therapist directly for each session at the time of service. After you are charged, you will be sent a details bill through Sessions Health which includes all the information insurance companies need. Depending on your out-of-network benefits, your insurance company may reimburse you for 50-80% of the session cost. Please contact your insurance company prior to using out-of-network benefits.
Superbilling can be a great way to blend the flexibility of private pay with the financial help of insurance. Project Passion Therapy is partnered with Mentaya - a service that submits superbills on your behalf to make getting reimbursed a headache-free process, they take 5% fee per claim for this service. Please inquire for more information.
If you choose to utilize OON benefits and submit claim through insurance they will require a diagnosis on file which your therapist will discuss with you prior to determination. For more information about the challenges when using insurance please see “Do you take insurance?” on my FAQ.
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Questions to ask Your Insurance Provider Before Utilizing OON Benefits:
Before starting with an out-of-network therapist, contact your insurance company and ask these key questions to understand your coverage and potential reimbursement:
1. Do I have out-of-network benefits for mental health services?
2. Do these benefits cover the following codes:
90837: Individual Psychotherapy, 53 minutes with patient
90847: Family Psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes
3. Do I have a deductible that needs to be met prior to me receiving reimbursement for out-of-network services? If yes, what is my deductible, and how much has already been met?
4. After my deductible is met, how much will I be reimbursed per session? (Individual Sessions: $175, Partnered Sessions: $200)
5. Are there limits on how many therapy sessions I can be reimbursed for each year?
6. How long does it typically take to receive reimbursement once I submit a superbill?
7. What is the process for submitting a superbill (e.g., online, by mail)?
8. Is pre-authorization needed for out-of-network mental health services?
By asking these questions, you’ll have a clear understanding of your benefits and how to maximize them.