Understanding Insurance and Resources

On this page you can find brief explanations of the following terms and concepts:

  • Superbills

  • Out-of-Network

  • HSA Accounts

 Superbill

A Superbill is essentially a receipt for behavioral health services. This is used to help clients get reimbursed for services. For example, when you attend a mental health therapy appointment there is typically a “service code” and “diagnostic code”, in addition to the date, and the amount you paid.

When you ask your therapist for a Superbill, and share it with your insurance company, know that you are disclosing personal health information (PHI). Please review privacy practices with your insurance carrier if you would like to better understand how they manage PHI.

Please read the following section to better understand what to expect on reimbursement.

Out-of-network (OON)

I am a self-pay provider. Also called an Out-of-Network Provider. An out-of-network (OON) provider is a healthcare professional (therapist, doctor, social worker, etc.) who does not hold a contract with your insurance carrier. OON providers are paid directly by clients or patients. They are not beholden to specific rules dictated by the insurance company, such as session time limits, service codes utilized, or diagnoses “covered”. Patients/clients can submit claims and request reimbursement after services have been rendered. The amount for which someone is reimbursed will be dependent on the carrier and the specific plan. For example you and a friend may both have Cigna insurance, but you may still have different coverage under your separate plans. Each plan has a unique policy.

These are some questions you can ask your insurance carrier when exploring the option of working with an OON provider:

  • Do I have OON coverage for behavioral health?

  • What is my OON deductible?

  • Once my deductible has been met, at what percentage does my plan cover OON behavioral health services?

Health Savings Accounts

The definition of a Health Savings Account (HSA) will vary from company to company. Often HSA’s are pools of money your employer offers you as a benefit to flexibly cover costs that are not covered by your insurance carrier directly. This may be a co-pay, massage appointment, physical therapy, or any out of pocket expenses, including behavioral health care. It is always recommended to review your company’s policy for HSA’s. Once you have deemed that your HSA can cover behavioral health services you then can give your account information, which typically works similar to a debit or credit card, to your therapist. The therapist can then offer you a receipt as needed.

For a brief guide to understanding HSA, FSA, and HRA, click HERE.