I am considered an out-of-network provider for all insurance plans. If your insurance plan includes mental health benefits and if you’re wanting to seek out-of-network reimbursement from your insurance company, it’s important for you to understand how the process works and what it requires, along with it’s disadvantages and potential benefits, so that you can make an informed decision about whether it’s the route you want to pursue or not.

At a minimum, seeking reimbursement from your insurance company requires that you meet criteria for a mental health disorder diagnosis. I can assess you for such a diagnosis if you request this of me up front. This assessment is something that usually takes a few session to complete. If you meet criteria for a mental health disorder diagnosis, that diagnosis will then be put on your permanent medical record when you submit for out of network reimbursement. After you submit your diagnosis on a superbill which I can provide you (containing information about the therapy services you’ve received), your insurance company will make a determination of whether they believe therapy is a “medical necessity” for you.

If the insurance plan decides therapy is a medical necessity for you, your plan will then notify you directly of the amount of therapy services for which they will reimburse you and number of sessions they will allow, which reimbursement usually applies after you have met have your deductible in full. These specifics vary by insurance plan. There is also a chance that you will go through that process and your insurance plan will decide that therapy is not a “medical necessity” for you.

One of the most important things for you to know about this process is that if you choose to submit for reimbursement from your insurance company, this subjects my records about you to the requirements of the insurance company and waives your rights to privacy and confidentiality as if I were paneled with the insurance company.