Reflections Mental Health Services

By Alphonso Gaita, LCSW · Reflections Mental Health Services · Telehealth across New York State

If your favorite therapist isn’t in your insurance network, don’t write off the relationship. Many insurance plans offer out-of-network therapy benefits, and you can use a document called a “superbill” to get partial reimbursement after the fact.

But the process is poorly explained almost everywhere. Here’s how it actually works in New York.

What is out-of-network coverage?

If you have an HMO, you usually have no out-of-network coverage — only in-network providers are reimbursed. If you have a PPO or POS plan, you typically have out-of-network benefits, which means your insurer will pay back a portion of what you pay providers outside their network.

Out-of-network coverage usually has its own separate deductible (often higher) and coinsurance percentage (often 50-70%, vs 80-90% in-network).

What is a superbill?

A superbill is an itemized receipt your therapist gives you after each session (or monthly). It includes:

• Your name and date of birth
• Therapist’s name, credentials, license number, NPI (national provider identifier), and tax ID
• Practice address
• Date(s) of service
• CPT codes (the medical billing codes for the services rendered — usually 90791 for intake, 90834 for 45-min session, 90837 for 60-min session)
• ICD-10 diagnosis code (a clinical diagnosis required for insurance claims)
• Amount you paid

You then submit the superbill to your insurance company through their online portal, by mail, or by fax. They process it and reimburse you according to your out-of-network benefits.

How to actually submit a superbill

1. Get the superbill from your therapist (most provide them automatically; some require you to ask).
2. Log into your insurance member portal and find “Submit a claim” or “Out-of-network claim.”
3. Upload the superbill as a PDF, along with proof of payment (a credit card receipt or bank statement).
4. Wait 4-8 weeks. Insurance companies are slow. They’ll send a check or direct deposit for the reimbursable portion.
5. Track everything. Keep a folder. If a claim is denied, you can usually appeal.

What you’ll actually get reimbursed

This varies wildly. Here’s a typical example:

• Session rate: $150
• Insurer’s “allowed amount” for that CPT code: $120 (insurance has its own rate, called UCR — Usual, Customary, and Reasonable)
• Out-of-network deductible: $1,000 (you pay this much before reimbursement starts)
• Coinsurance after deductible: 60%
• Once deductible is met, you’d get back: $120 × 60% = $72 per session

So your effective out-of-pocket on a $150 session, after meeting the deductible, would be roughly $78.

When out-of-network is worth it

• When you’ve found a therapist who’s the right fit — clinical match matters more than insurance
• When you have a PPO with reasonable out-of-network coverage
• When the in-network options have months-long waitlists (a common NY problem)
• When your specific need is specialized (EMDR, ERP for OCD, eating disorder treatment) and in-network options are limited

What to ask your insurance about out-of-network

1. Do I have out-of-network mental-health benefits?
2. What’s my out-of-network deductible, and how much have I met this year?
3. What’s my coinsurance percentage after the deductible?
4. What’s the allowed amount (UCR) for CPT codes 90834 and 90837?
5. How do I submit a claim, and what’s the expected processing time?

We’ll provide your superbill automatically

At Reflections, we’re in-network with Aetna and Blue Cross Blue Shield. For all other insurers, we provide a superbill after every session so you can submit for out-of-network reimbursement. Full insurance details here, or schedule a free consultation and we’ll verify your specific benefits before your first session.

References

• American Medical Association. (2024). CPT Code Set: Psychotherapy Services.
• Centers for Medicare & Medicaid Services. (2024). Mental Health Parity and Addiction Equity Act.
• New York State Department of Financial Services. (2024). Out-of-Network Coverage Requirements.
• Kaiser Family Foundation. (2024). Out-of-Network Use of Mental Health Services.