Your Financial Therapist is Out of Network: Now what?
Financial Therapy in California is an investment you make in your mental health as well as your finances. Financial Therapists may be Out of Network Providers. Navigating the use of your medical insurance benefits may seem daunting.
This blog post outlines different ways to access or support your journey to mental and financial wellbeing. If you have questions about using your private medical insurance or your Flexible Spending Account (FSA) for psychotherapy, keep reading to explore some of my Frequently Asked Questions.
If Koru Financial Therapy is an out-of-network provider, can I use my insurance?
Koru Financial Therapy provides mental health services to residents in California. As indicated by the name, the focus of therapy is on financial concerns such as Money Disorders, financial stress, or anxiety. Koru Financial Therapy, however, can assess, diagnose, and treat all mental health conditions.
Koru Financial Therapy does not take private medical insurance, meaning you would pay directly for therapy services via a 3rd party payment vendor where your card is charged at the end of each session. This makes Koru Financial Therapy an Out-of-Network (OON) provider according to your insurance, meaning, we are not contracted with your insurance, and reimbursement is not guaranteed unless specifically outlined in your policy. Koru Financial Therapy can, however, provide you with a super bill that you can submit to your insurance for possible partial or full reimbursement. If you are hoping to be reimbursed for therapy, it is encouraged you call your insurance directly to inquire about your out-of-network coverage before beginning services with Koru.
What questions should I ask my insurance company before starting services Koru Financial Therapy if I want to use my insurance?
OUT OF NETWORK (OON) BENEFITS
Depending on your health insurance plan, your insurance company may help reimburse a portion of the cost by mailing you a check. If you have a Preferred Provider Organization (PPO) or Point of Service (POS) health insurance plan, you’ll get back partial reimbursement for out-of-network services, making therapy more cost-effective and budget-friendly.
Check your OON benefits.
These are typically in the Summary of Benefits, included in a member information packet or on your insurance company website. Keep an eye out for these terms:
Out-of-network deductible: This is the amount of money you have to pay before you are eligible for reimbursement.
Co-insurance: This is the percentage of the service fee that you’re ultimately responsible for paying
Call your insurance company to verify your benefits
The best way to be sure of your benefits is to clarify with your insurance company member services line. You can find this phone number on the back of our insurance card or through your online insurance platform.
Ask these questions when speaking to your insurance company about benefits:
Do I have OON coverage for mental health services provided through telehealth?
How many sessions per year does my plan cover?
How much of my deductible has been met this year?
What is my OON deductible for outpatient mental health? (Outpatient means treatment outside a hospital)
How much does my insurance plan reimburse for OON providers for CPT codes 90834 and 90837?
Does my insurance plan cover Z codes for couples therapy?
What is my co-payment (if applicable)?
Do I need prior authorization?
Do I need a referral from an in-network provider to see someone out-of-network?
How do I submit claim forms for reimbursement? (Claims are forms that are sent to your insurance company to receive reimbursement for sessions you paid for out of pocket.)
What is the home and mailing address on my file? (Important to ensure checks are issued to the correct address).
What is the time limit to submit a super bill?
*CPT codes refer to the type of service you received. CPT code 90834 refers to a clinical 45-minute session and CPT code 90837 refers to a 60-minute session (a clinical hour is typically 53 minutes to allow time for documentation) with a modifier (02) after the code to indicate services took place over teletherapy.
*Z codes are typically not covered by insurance. These codes should include problems related to Employment and Unemployment (Z56) Z56.O, Problems related to Housing and Economic Circumstances (Z59) Z59.O, and Problems in Relationship with Spouse or Partner Z63.). For this reason, couples therapy is not typically covered by insurance but be sure to check with your insurance about your specific out-of-network coverage.
What is a super bill?
A super bill is a document, like an invoice or receipt, that outlines the services you received with your therapist. It is generated by the 3rd party vendor and sent to you automatically after each session with payment. It must include the following information to be considered for reimbursement:
Client name, address, and date of birth
Therapist name, phone number, and email
Therapist Tax ID and National Provider Identifier (NPI)
Statement number and date issued to liens
A diagnosis and diagnosis code (also called a COT code)
Service type, date, and code for reimbursement
The fees that you paid
Receive OON reimbursement!
You’ll need to pay the entire session fee at the time of service, but depending on your specific plan, your insurance company will mail you a check to reimburse a portion of that cost. There are even apps for that! Using an app like Reimbursify can help you navigate the reimbursement process in a few clicks.
What are some points to consider before I decide to submit a super bill to my insurance?
When exploring your options for reimbursement, keep these points in mind about therapy.
Reimbursement requires a diagnosis – a super bill, just like any other paperwork submitted to insurance for reimbursement, requires a clinical diagnosis as classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-10). Examples of diagnoses and their codes can include:
Compulsive Buying Disorder (F63.8)
Gambling Disorder (F63.0)
Adjustment Disorder, With depressed mood (F43.21) or Anxiety (F43.22)
Adjustment Disorder, Unspecified (F43.2)
Post-Traumatic Stress Disorder (F43.10)
Major Depressive Disorder (296.20-36)
Autism Spectrum Disorder (299.0)
Anxiety Disorder (300.2)
Bipolar I disorder, Current or most recent episode depressed, In partial remission (F3175)
And, many more
How do I submit my super bill?
Insurances typically have a time limit to turn in your super bill of 90 days or more, some up to 180 days. This can fall under “timely filing”. To submit your super bill, contact your insurance company and ask for “member services” or check their website for instructions. There are usually 3 options for turning in super bill mail, fax, or through an online portal.
Mail – you can ask your insurance for an address to mail the super bill. Make sure you allow time for delivery to stay within your time limit for timely filing.
Fax – if you would like to keep your protected health information private, we suggest not faxing from a public fax machine (such as the library) or a work fax machine. The receipt that shows your fax was sent will include the private health information.
Online portal – most insurance providers will have an online portal through which you can upload your super bill. It is the most secure option to send your super bill as the website will request a login or password. It is also faster than mail or fax. Be sure to ask your insurance about this option.
What can you expect after you submit a superbill?
Insurance companies typically have a time limit in which you can submit a super bill. If you submit your super bill after this time limit, you risk losing any potential reimbursement.
It can take your health insurance 2-4 weeks to process your super bill. They will either pay the full amount of services minus your copay, or they will put this amount towards your deductible. If your super bill is denied, call your insurance and request information about the denial.
*Adapted from blog.zenare.co and Revive Counseling and Consulting.
Does private medical insurance cover couples therapy?
Insurance does not typically reimburse couples therapy. Your insurance requires a diagnosis to prove that your therapy is “medically necessary” not just that you are experiencing stress or are having issues in your relationship. For this reason, couples therapy is not typically reimbursed by insurance providers. Talk to your insurance and therapist about specific coverage for couples therapy.
Flexible Health Spending or Reimbursement Accounts (FSA/HSA/HRA)
Can I use my Flexible, Health Spending or Reimbursement Account (FSA/HSA/HRA)?
Psychotherapy or counseling expenses are FSA or HSA eligible only if they are for medical care. Therapy or counseling used for the general improvement of mental health without a medical diagnosis (such as marriage counseling) is not eligible.
Want to know more about how therapy works with Koru Financial Therapy?
Explore Koru Financial Therapy’s BLOG which offers information, support, and tips on how to create a healthy relationship with money.
Do you identify as having ADHD? Read about ADHD and money matters. Or, discover services specifically tailored to support ADHD.
To access Koru Financial Therapy services which include individual, couple, family, or group sessions, follow the steps below:
Reach out to schedule a free 20-minute phone consultation.
Speak with Mariah, a certified financial therapist.
Start your journey to growth, strength, and peace.
Financial Therapy topics can include, building generational wealth, financial infidelity, neuro money, financial PTSD, financial caregiving, or enmeshment, amongst many others.
About the Author
Mariah is a licensed mental health practitioner specializing in financial therapy. Her focus lies in addressing mental health concerns related to finances, such as money disorders, financial stress, or anxiety. While her services encompass mental health treatment broadly, they specialize in financial-related issues.
One notable aspect, of Koru Financial Therapy, is they operate as an Out-of-Network (OON) provider, meaning they don’t directly accept private medical insurance for payment. Instead, clients pay for services directly, and the author provides a super bill, an invoice-like document, which clients can then submit to their insurance for potential reimbursement. Koru Financial Therapy offers guidance on navigating insurance coverage for mental health services and provides resources to help clients understand their out-of-network benefits.
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