A Guide to Using Insurance for Therapy

Getting started with therapy is a big and meaningful step, and figuring out how to use your insurance shouldn’t hold you back. At Sustainable Wellness, we’re here to make the process as simple and supportive as possible, whether we’re in-network with your insurance provider or helping you make the most of your out-of-network benefits. Here’s a quick guide to understanding how insurance works when it comes to mental health therapy:

Can I use insurance for mental health therapy?

Most health insurance plans include some level of coverage for mental health care, including outpatient therapy. However, the specific amount covered can vary depending on your specific plan. We always recommend contacting your insurance company directly to see what your specific plan covers. Common questions you could ask your insurance provider include:

• Do I have outpatient mental health or behavioral health benefits?

• Do I have a deductible (and, if so, how much is it and how much has been met)?

• What is my copay or coinsurance for mental health visits?

• Are Telehealth services covered under my plan?

We’re In-Network with several insurance providers

Our practice is in-network with several insurance companies. This means we have agreements in place with these providers to offer therapy services at a lower out-of-pocket cost to you. If you have an insurance plan that we accept, we will verify your benefits prior to starting therapy services and bill your insurance directly after each of your visits.

Not sure if we’re in-network with your plan? Check out our Rates & Insurance page, or contact us directly. We’re happy to provide you more information!

Out-of-Network? We can still support you!

Even if we're not in-network with your insurance provider, you may still be able to get a portion of therapy covered through your out-of-network (OON) benefits. "Out of Network" means that our practice does not have a contract with your insurance provider. Just like with in-network benefits, the specific amount that your insurance provider covers will depend on your plan.

The out-of-pocket cost is often higher when using OON benefits, however this varies greatly among plans and is not always the case. Some insurance plans offer generous OON coverage, and we always recommend asking your insurance provider what your plan covers.

Our practice offers two types of support for out-of-network billing:

Out-of-Network Billing

Out-of-Network billing means we bill your insurance company on your behalf, just like we do for in-network plans. This helps reduce the need for clients to submit paperwork themselves—a reality that often exists when using OON benefits due to there being no contracts between therapists and insurance providers. With out-of-network billing, our team:

• Collects your insurance information during intake

• Verifies your out-of-network mental health benefits

• Submits claims electronically after each session

• Monitors claim status and notify you if any issues arise

Please note that not all insurance plans allow third-party submission of out-of-network claims, so we are only able to do this with some providers. Our Rates & Insurance page has the most up-to-date information about our Out of Network billing options, or you can always contact us directly for more information.

Superbill

If your insurance provider requires that you submit your own claims, or Out of Network billing is not an option for other reasons, we can provide you a monthly superbill to send to your insurance company for reimbursement of services. Superbills are essentially detailed receipts specifically tailored to include everything insurance might need to determine eligibility for reimbursement.

When using superbills, clients are required to pay up front for the cost of therapy. Then, our practice provides the superbill to the client (usually on a monthly basis), and the client submits the superbill to their insurance company. The insurance company then processes the claim and, if eligible, the client will receive (partial) reimbursement for the session. The reimbursement money is paid directly to the clients—not to the therapist or practice.

Key terms to know

Understanding a few insurance basics can go a long way:

• Copay – A flat fee you pay per therapy session (i.e. $25).

• Deductible – The amount you pay out of pocket before your insurance begins contributing.

• Coinsurance – A percentage of the session fee, which you’re responsible for paying after you reach your deductible.

• In-Network – The practice has a contract with your insurance provider.

• Out-of-Network – The practice does not have a contract with your insurance provider.

We’re here to help!

Our team is committed to helping you understand your options and access the support you need. If you’re unsure about your benefits or how to get started, contact us—we’re happy to help you navigate next steps.