Getting access to mental health care can be a challenge for many people, particularly those in the LGBTQ community. Even when you find a therapist you like, the cost of therapy can prevent you from accessing the care you need. Fortunately, there are options available that can help make therapy more affordable. One such option for people with insurance is using out-of-network benefits to pay for therapy.
Using out-of-network benefits involves something called a “superbill.” Below we'll explain what a superbill is, how it works with your insurance plan, and how to use it to get reimbursed for telehealth or in-person therapy appointments.
In-network versus out-of-network providers
Working with a therapist that takes your health insurance plan means you work with an In-network therapist. In-network therapists are typically more affordable than out-of-network mental health providers. However, thanks to superbills, out-of-network providers may also be affordable for individual therapy and psychotherapy.
Why choose out-of-network benefits?
Though it's common to seek therapists within your health insurance to avoid costly out-of-network deductibles, sometimes, an out-of-network therapist is the best choice for your therapy. With many people turning to telehealth for therapy, finding a therapist who truly gets you is easier than ever.
What is a superbill?
A superbill is a document that contains information about the services you received from your therapist or mental healthcare provider. It includes:
- Dates of service or sessions
- Type of service provider, including diagnosis code
- The full fee for services
- The total amount billed
- Contact information about your therapist or mental health provider and their practice
- Your date of birth, legal first and last name (needed to match your insurance), and contact info
- Your therapist or mental health provider's NPI number
You can use a superbill to request reimbursement from your insurance company if your therapist is out-of-network. Superbills are similar to detailed receipts for therapy or services from an out-of-network provider. A superbill may also be referred to as a claim form, invoice, or statement of services.
How do out-of-network benefits work?
Suppose you have out-of-network benefits through your insurance plan. In that case, you can use a superbill to request reimbursement for therapy services. Some health insurance plans may offer partial reimbursement for out-of-network services by mailing you a check. You may be required to pay for the session upfront and then submit a claim for reimbursement afterward. (Your insurance provider can tell you what forms you need to submit regarding your medical bill.)
If you have a PPO or POS health insurance plan, you could get some money back for mental health out-of-network services. Partial reimbursement can make mental health services more affordable. These benefits vary depending on your insurance plan, but they generally cover a percentage of the cost of therapy.
How to use a superbill or out-of-network benefits to pay for therapy
First things first, understand your out-of-network benefits with your insurance policy. You want to look up your out-of-network deductible and any coinsurance you may have for mental health or behavioral healthcare. Then, you can call your insurance company by finding the phone number on the back of your insurance card. If you have a healthcare navigator or navigation platform, you can also ask them for help.
Questions to ask your insurance company:
- Has my deductible been met this year?
- What is my out-of-network deductible for (outpatient) mental health or behavioral health?
- What is my out-of-network coinsurance, if any?
- Do I need a referral from an in-network provider to see an out-of-network therapist?
- What is the process for submitting claim forms for reimbursement?
Why do some therapists use superbills?
Sometimes, it's easier for a therapist or mental health provider to use superbills. The process can be easier and quicker than becoming an in-network provider. Dealing with insurance can be tricky on both ends!
- Makes therapy more affordable
- Is a request made by you as a patient or member (the power is in your hands!)
- Requires specific information to be documented on a reimbursement form
- Is submitted to the insurance company so you can get reimbursed
Deductibles, coinsurance, and health savings accounts
What are deductibles and coinsurance? How can you use insurance benefits like an HSA or FSA towards a superbill?
Coinsurance: Coinsurance is the percentage of the service fee that you're responsible for paying. For example, let's say you have a coinsurance rate of 20%. If you have a medical bill for $100, you would be responsible for paying $20 (20% of the total cost). Your insurance company would pay the remaining $80.
Coinsurance is a health insurance cost-sharing mechanism where you and your insurance company both pay a portion of your healthcare costs according to a predetermined percentage.
Deductible: A deductible is a set amount of money that you have to pay out of your own pocket before your health insurance starts covering your medical expenses. Not all insurance plans have deductibles.
HSA: An HSA (Health Savings Account) is a type of savings account you can use to pay for medical expenses. You contribute money to the account before taxes are taken out of your paycheck, and you can use the funds to pay for medical expenses, such as doctor's visits, therapy, prescriptions, and certain medical procedures.
FSA: An FSA (Flexible Spending Account) is a type of savings account that allows you to set aside pre-tax money to pay for eligible medical expenses, including therapy.
How to ask your therapist for a superbill
If you want to see an out-of-network therapist, ask if they can send the medical bills or claims to your insurance company for you. Some therapists will, but often you have to do it yourself. This is an important step for getting reimbursed for paying the full fee for services.
Your therapist or provider will give you a superbill form that shows the total service fees and how many sessions you had. You have to send this form to your insurance company at the end of every month.
Here are the steps you can take:
- Attend your therapy session and pay for it out-of-pocket. Be sure to obtain a superbill from your therapist that lists all the necessary information, including the provider's name and NPI number, the services provided, and the costs associated with each service.
- Submit the superbill to your insurance company along with an insurance claim form. The claim form will vary depending on your insurance provider, but you can typically find it on their website or by calling customer service.
- Wait for your insurance company to process the claim form. The time it takes for the claim to process can vary depending on your insurance provider, so it is best to check with them for an estimated timeline.
- Receive reimbursement! If your insurance plan offers out-of-network coverage, they will typically reimburse you for a portion of the cost of therapy. The reimbursement amount will depend on your specific plan, so always check with your insurance provider to understand your benefits.
Using a superbill for out-of-network benefits can help reduce the cost of therapy for LGBTQ individuals who need mental health care. However, it is important to note that not all insurance plans cover out-of-network services. Additionally, if you are struggling to afford therapy, there may be other options available to you, such as sliding scale fees or community-based mental health clinics.
FOLX can help members access out-of-network benefits by sending a superbill, or itemized invoice, to your email each month to submit to your insurance provider. To access a superbill form for your FOLX clinician and mental health services, log into your Athena Patient Portal. Toggle to "my health" and then select "medical forms." Select the "superbill invoice" to print or download. FOLX makes it less cumbersome to seamlessly get your superbill.
FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include expert, gender-affirming virtual primary care, gender-affirming hormone therapy including estrogen and testosterone, mental health care, sexual health care, and preventative care. We offer FOLX memberships that give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ referrals, and more. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-friendly healthcare with FOLX. FOLX Health is healthcare that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!