Out-of-Network Therapy and Superbills
How out-of-network therapy works, and how to use your benefits.
Most people assume that "doesn't take my insurance" means "I can't afford this." Often it doesn't. Many insurance plans include out-of-network benefits that go unclaimed simply because nobody mentions they exist.
This page explains how that works, so you can find out what your plan actually covers before you rule anything out.
What is a superbill for therapy?
A superbill is an itemized receipt for the therapy you've already paid for, formatted the way your insurance company needs it.
It contains everything an insurer requires to process an out-of-network claim: my name, credentials and practice details, my NPI and tax ID, the dates of your sessions, the service codes, your diagnosis code, and what you paid.
You pay me at the time of the session. I provide the superbill. You submit it to your insurance company, and if your plan includes out-of-network mental health benefits, they reimburse you directly at whatever rate your plan sets.
The therapy costs the same either way. The superbill is what lets you claim part of it back.
How the process actually works
1. Check your benefits first. Call the number on your insurance card and ask the questions in the next section. Five minutes on the phone tells you whether any of this applies to you.
2. Attend your sessions and pay at the time. HSA and FSA cards work here, as do credit and debit cards, cash and check.
3. Ask me for a superbill. I provide it — monthly is what most clients find easiest.
4. Submit it to your insurer. Most now accept uploads through their member portal or app. Some still want a claim form attached.
5. Reimbursement comes to you, not to me, at whatever rate your plan sets and after your out-of-network deductible has been met.
Call member services and ask these directly. Write down the answers and the date you called.
Do I have out-of-network outpatient mental health benefits?
What is my out-of-network deductible, and how much of it have I met this year?
Once the deductible is met, what percentage of the session fee do you reimburse?
Is that percentage based on what I paid, or on an allowed amount you set? If it's an allowed amount, what is it for CPT code 90837?
Do I need pre-authorization or a referral?
How do I submit a claim, and is there a deadline after the date of service?
That last question catches people out. Some plans will not accept a claim more than 90 days old.
Why I'm out of network
I'm no longer accepting new insurance clients, and that's an intentional choice about the quality of care for clients.
Insurance panels require a mental health diagnosis in order to authorize and/or cover sessions, which means everyone gets diagnosed whether or not a diagnosis fits. Plenty of what I work with — infertility grief, a difficult birth, the identity shift into parenthood — is not a disorder, and it doesn't belong in a permanent medical record as one.
Insurers also decide how many sessions are medically necessary and can stop authorizing them at any time. Being out of network means the length of your therapy is a clinical decision we make together, not an administrative one made by someone who has never met you.
And there's the record itself. A diagnosis submitted to insurance is part of your medical history from then on. Some clients would rather that didn't happen for many reasons including but not limited to the impact of mental health diagnoses on life insurance premiums.
What to ask your insurance company
Rates
Service, Length, Fee
Individual therapy, 50 minutes, $140
Individual therapy, first session 50 minutes, $165
Couples therapy, 50 minutes, $165
Art therapy, 50 minutes, $150
Third-party reproduction evaluation, 120 minutes, $280 (summary report included)
Group therapy, 90 minutes, $40 per person
Professional consultation, 50 minutes, $150
Fair Play facilitation, individual — $150
Fair Play facilitation, couples — $175
Fair Play workshop — $100 per person or couple
Payment: HSA, FSA, most major credit cards, debit cards, cash and check.
If the fee is the obstacle, say so
Therapy scholarships are available, and a limited number of reduced-fee spots open up as schedules change. Both are by inquiry, and asking costs nothing.
If I'm not the right fit financially, I'd rather help you work that out on a free consultation call than have you decide in advance that it's out of reach.
Training in reproductive mental health
Katie Kirkenmeier, MA, LPC, LCPC, ATR, PMH-C
Empty Cradle, Broken Heart: A Practitioner's Guide to Working with Bereaved Families — 18-hour advanced course
Certified in Perinatal Mental Health (PMH-C)
Postpartum Support International, two-day Perinatal Mood Disorder Components of Care training
EMDR Level 1 and 2 trained
Registered Art Therapist (ATR)
Member of the Mental Health Professionals Group of the American Society for Reproductive Medicine
Licensed Professional Counselor in Missouri and Licensed Clinical Professional Counselor in Kansas
Questions about out-of-network therapy and superbills
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No, there are no guarantees of insurance reimbursement. It depends entirely on your plan — whether it includes out-of-network mental health benefits, what your deductible is, and what rate it reimburses at. The questions above tell you before you commit to anything.
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It varies too much for a useful average. Some plans reimburse a substantial share after the deductible; some have no out-of-network benefit at all. Your insurer is the only reliable source.
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Yes. Insurers won't process a claim without a diagnosis code, so a superbill has to carry one. If you'd rather no diagnosis be recorded anywhere, you can simply choose not to use a superbill and pay privately — that's a legitimate choice and some clients make it deliberately.
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Yes. Therapy is an eligible expense for both, and you can use those funds whether or not you ever submit a superbill.
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Often, yes — this is exactly what out-of-network benefits are for. Ask your insurer the questions above about your current provider's fee.
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Monthly works for most people. Just ask, and I'll provide it.
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There are a limited amount of sliding scale, or reduced fee, spots available. Please ask during the consultation call if this is something you think you may need.
Talk it through before you rule it out
Book a free 15-minute consultation, send me a message or text 816-875-0078.
I reply within two business days.
If the cost is what's stopping you, that's worth one phone call to check rather than a decision made on an assumption.