out-of-network insurance

understanding your insurance coverage for mental health

how do I use my out-of-network insurance?

All of our clinicians and counselors are out-of-network providers.

That means we are not paneled with any specific insurance companies, and full session fees are due at the time of service.

Depending on your current health insurance provider or employee benefit plan, it is possible for your counseling services to be covered in full or in part.

Learn how to understand your specific coverage and how to request reimbursement from your insurance provider.

 

what is my out-of-network coverage?

The first step in deciding whether or not to seek reimbursement from your insurance is to find out what type of coverage your plan offers for out-of-network mental health.

You can confirm your own insurance benefits by calling the number on the back of your insurance card.

We recommend asking these questions to your insurance provider to help determine your out-of-network benefits:

  • Does my health insurance plan include mental health benefits for out-of-network providers?
  • Are sessions with LPC-Interns covered?
  • Do I have a deductible? If so, what is it and have I met it yet? When does my deductible re-up?
  • Does my plan limit how many sessions per calendar year I can have or limit the frequency of sessions? If so, what is the limit?
  • Do I need written approval from my primary care physician in order for services to be covered?
  • Will my counselor be required to provide a diagnosis for my permanent medical health record in order for me to be reimbursed? Is my coverage limited to certain diagnoses?
  • Will synchronous video telehealth sessions (online counseling) be covered the same as in-office sessions? If not, what is the difference in coverage or reimbursement?

 

how do I get my insurance company to reimburse me?

In order to submit your session fees to your insurance company for reimbursement, you will need a “Superbill.”

A superbill is an insurance-specific term for an invoice or receipt.

The superbill includes the specific information your insurance company needs including your diagnosis, your therapist, the type of service you received, and the fee you paid for the services.

At The Joy Effect, your client portal will automatically generate a new superbill on the 10th of each month you are attending sessions.

All you have to do is login to your Joy Effect client portal and download your superbill each month to submit to your insurance.

If you need a superbill more frequently than once each month, you can ask your counselor to create one at any time.

Once you have your superbill, you will submit it to your insurance company in whatever way they request.

Some insurance companies allow you to submit online.

Others partner with apps to make submission of superbills even more convenient.

Your insurance company will review the claim, and reimburse you for any out-of-pocket expenses that are covered in your out-of-network mental health benefits.

So I have to pay the full fee each time?

Yes, you pay the agreed-upon fee for your therapist each session. 

Any reimbursement from your insurance company will go directly to you, and not back to your therapist.

At The Joy Effect, we require a credit/debit card to remain on-file as long as your case is open.

We will charge the card on file each session unless you specifically request an alternative form of payment.

If you would prefer to pay using cash or check, you can let your therapist know.

Your credit/debit card will remain on file for late cancellation or missed appointment fees.

What if I can’t make it to my appointment?

If you are unable to attend a session, please make sure you cancel at least 24 hours beforehand. Otherwise, you will be charged for either a partial or full session fee.

Your therapist will include information about these fees in your intake paperwork.

 

how do I find a counselor who takes my insurance?

If, after learning more about your coverage, you decide you’d prefer to work with an in-network provider (someone who accepts your insurance), in addition to the above questions, you can also ask your insurance the following:

  • Where can I find a list of in-network providers?
  • What are my benefits for in-network providers for mental health care?
  • Is my coverage limited to certain diagnoses?

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