How to Get Insurance to Cover Out-of-Network Therapy Hassle-Free
You already have to pay for health insurance, so you’d like to use your benefits to help pay for therapy.
I’m an out-of-network therapist, meaning I do not contract with any health insurance companies directly, but many of my clients still get the majority of the fees paid by their health insurance. Here’s how:
Understanding Out-of-Network Therapy Coverage in Santa Rosa
How do I know if my health insurance company offers reimbursement for out-of-network therapy?
Depending on your health insurance plan, most PPO-type health insurance plans offer some “out-of network” reimbursement for mental health care.
You can call your health insurance company to find out the specifics. (Alternatively, you can skip the unpleasant phone calls with the insurance company by going through Thrizer, a service I will explain later on in this article)
Here’s what to say:
“I am seeking outpatient mental health benefits in a professional office setting. Does my plan cover out-of-network providers for this service?”
How much will I get reimbursed for the sessions?
Your particular health insurance plan should be able to outline the amount of reimbursement you could receive.
You can also find out quickly and easily through Thrizer, which I will outline in option 2.
If you do decide to call your health insurance company directly, here are the questions you’ll want to ask to calculate how much you might get reimbursed:
“What is my coinsurance?”
“What is my Out-of-Network deductible?” (The deductible is the amount you must yourself before the health insurance plan begins paying towards your therapy). You may have a separate deductible for in-network providers and one for out-of-network providers.
“How much of the out-of-network deductible has been met so far this year?”
“My therapist charges $_______. Is this within the Allowed Amount or UCR (Usual, Customary, and Reasonable Fee) for an Out-of-Network Provider?”
Navigating Health Insurance for Sonoma County Therapy
Option 1: Superbills help maximize Insurance Benefits for Your Therapy
I provide my clients with superbills once a month. Clients pay for their sessions directly to me (using a credit card, health spending account/flexible health spending account card, or check), and at the end of the month, I provide a detailed receipt, called a superbill.
A superbill is a document that outlines the dates of sessions, times, a diagnostic code, my information as a licensed therapist, the fees that were paid by the client, and other relevant information a health insurance company might want.
Clients then submit this superbill to their health insurance company by email, snail mail, fax, or sometimes through the health insurance website. The insurance company reviews, (this sometimes happens quite quickly, however some report it can take multiple weeks to get processed) and sends a check for a portion of the paid session fees depending on the out-of-network benefits of your specific plan (see the questions to ask your health insurance that I covered previously).
Option 2: New Service for Insurance Reimbursement- Thrizer
Sign up with Thrizer and input your health insurance information and they will figure out if you have out-of-network benefits. I am a provider with Thrizer, which allows you to utilize any of their services while you are working with me.
Thrizer does the calculations for you. They let you know your deductible and estimated out-of-pocket cost for therapy with me. Super quick and easy. NO phone calls to health insurance, yay!
They allow you an option to pay just the co-insurance for sessions after you meet your deductible. This means you don’t have to pay my full rate upfront, submit a superbill, and wait for the reimbursements (which as we talked about above, can take weeks, sometimes months, and some back-and-forth with the insurance companies).
How can I use this service for out-of-network psychotherapy in Sonoma County?
I will email you a link to create your Thrizer account
Add your insurance information and a payment method to set up your account
Review your out-of-network benefits and estimated co-insurance to clarify any questions you have
I will charge you via Thrizer for our appointments
What does it cost to use Thrizer?
It’s free to use if you just want to use the service for submitting superbills, having their team handle the communications with the insurance, and then getting reimbursed via direct deposit once the insurance company has processed your claim.
If you’d like to utilize the service that allows you to pay just your co-pay/co-insurance (while Thrizer floats the rest and does the waiting for you) then it costs 5% of the session fee.
Now that the money stuff is not holding you back, ready to start therapy?
When you are already struggling with life stuff, the last thing you want to do is add another task of dealing with your health insurance company.
I make the process of starting therapy super easy, including offering the help of providing you detailed superbills or Thrizer services on the financial side of things.
I am a Santa Rosa therapist who specializes in adults who feel stuck with anxiety, anger, self-doubt, and negative thinking that gets in the way of fulfilling relationships.
I offer online counseling to anyone residing in California and in-person counseling for Sonoma County.
Skip the phone tag and schedule a free 15-minute phone consultation into my online calendar here:
Angela Sitka, LMFT, has a private practice in Santa Rosa, CA specializing in helping adults with relational problems, including relationship anxiety, men’s relationship issues, divorce recovery and young adults.