Many people assume that seeing a psychiatrist who doesn't take insurance means paying everything out of pocket. Often that isn't true. If your plan has out-of-network benefits, you may be able to get part of the cost back using a superbill.
What a superbill is
A superbill is a detailed receipt in the format insurance companies use for claims. It includes:
- The provider's name, credentials, NPI number, and tax ID
- Dates of service
- Procedure codes (CPT codes) for each visit, such as 90792 for a psychiatric evaluation or 99214 for a follow-up visit
- Diagnosis codes (ICD-10)
- The amount you paid
My practice sends a superbill every month, so all you have to do is submit it.
Step 1: Call your insurance company first
Use the number on the back of your card and ask about out-of-network outpatient mental health benefits. Good questions to ask:
- Do I have out-of-network benefits for outpatient mental health?
- What is my out-of-network deductible, and how much have I met this year?
- After the deductible, what percentage do you reimburse?
- How do you calculate the allowed amount for CPT codes 90792 and 99214?
- Do I need pre-authorization?
- Where do I send claims, and is there a deadline?
Write down the date, the representative's name, and a reference number for the call.
Step 2: Submit the superbill
Most insurers let you upload claims through their website or app. Some require a claim form with the superbill attached. Submit each month's superbill promptly, since many plans have filing deadlines.
Step 3: Know what to expect
Reimbursement is based on the insurer's allowed amount, which is often less than what you paid. You'll typically get a percentage of that allowed amount after your deductible is met. Also, insurers reimburse visits, not membership features like messaging or priority access, so a monthly membership will usually be only partly reimbursed. PPO plans are the most likely to have out-of-network benefits. HMO and EPO plans often don't.
HSA and FSA funds
Psychiatric evaluations, follow-up visits, and medication management are generally eligible expenses for Health Savings Accounts and Flexible Spending Accounts. You can usually pay directly with your HSA or FSA card. Check with your plan administrator about membership fees specifically.
Your right to a Good Faith Estimate
Under the federal No Surprises Act, if you're paying out of pocket or not using insurance, you have the right to receive a Good Faith Estimate of expected charges before your care begins. If your final bill is substantially higher than the estimate, you may be able to dispute it. I send every new patient a Good Faith Estimate with their welcome packet.
A quick example
Say your plan reimburses 60% of the allowed amount after a $1,000 out-of-network deductible, and it allows $300 for an evaluation. Early in the year, your payments go toward the deductible. Once it's met, you'd get back about $180 for a visit with a $300 allowed amount. Your actual numbers depend entirely on your plan, which is why that first phone call matters.
This article is general information, not medical advice for your situation. If you're in crisis, call or text 988, or call 911.