Understanding Out-of-Network Benefits & Superbills

Written by Kirsten Tretbar

Updated last week

Tretbar Therapy LLC is an out-of-network provider for all insurance plans. This means we do not directly bill insurance companies or participate in any insurance panels. However, you may still be able to use your insurance benefits to help cover the cost of therapy if your plan includes out-of-network mental health coverage. This page explains how that works using a "superbill."

What Does "Out-of-Network Provider" Mean?

Being an out-of-network provider means:

• We do not have a contract with your insurance company.
• We do not verify your insurance benefits or handle pre-authorizations.
• You are responsible for paying the full session fee directly to Tretbar Therapy LLC at the time of service. (See our Fees and Payment Policies).

However, many PPO and POS insurance plans offer benefits for services received from out-of-network providers.

What is a Superbill?

A superbill is essentially a detailed, itemized receipt for health care services you have received and paid for. It contains specific information that insurance companies require to process a claim for potential reimbursement.

A superbill will typically include:

• Your name, date of birth, and address.
• Our practice name, address, and NPI (National Provider Identifier) number.
• Kirsten Tretbar's LMFT license number.
• Dates of service.
• CPT codes (Current Procedural Terminology) for the services provided (e.g., 90834 for individual therapy, 90847 for family/couples therapy).
• Diagnosis code(s) (ICD-10), if applicable and with your consent to include.
• Fees charged and a record of your payment.

How to Use a Superbill for Potential Reimbursement

1. Pay for Your Sessions: You will pay Tretbar Therapy LLC the full session fee at the time of service.
2. Obtain Your Superbill: Request and receive your superbill from us.
3. Contact Your Insurance Company:
   • Call the member services number on the back of your insurance card.
   • Ask about your "out-of-network mental health (or behavioral health) benefits."
   • Find out their process for submitting out-of-network claims (they may have a specific form or an online portal).
4. Submit the Claim: Submit the superbill (and any required claim form from your insurer) directly to your insurance company according to their instructions.
5. Reimbursement (if applicable): If your claim is approved and you have met any deductibles, your insurance company will reimburse you directly for a portion of the fee, based on your plan's out-of-network coverage rates.

Important Questions to Ask Your Insurance Company

Before starting therapy, or when considering using out-of-network benefits, it's highly recommended you ask your insurance provider the following questions:

• Do I have out-of-network mental health (or behavioral health) benefits for outpatient therapy?
• What is my annual out-of-network deductible, and have I met it yet? (A deductible is the amount you pay out-of-pocket before your insurance starts to reimburse).
• What percentage of the session fee (or "usual and customary rate") do you cover for out-of-network providers once my deductible is met?
• Is there a limit on the number of sessions per year that are covered?
• Do I need a pre-authorization or referral to see an out-of-network mental health provider?
• What is the process for submitting claims for out-of-network services? Is there a specific form I need to use in addition to the superbill?
• What is the typical timeframe for processing out-of-network claims and receiving reimbursement?
• Are there specific CPT codes (e.g., 90834 for individual, 90847 for family/couples) that are covered or not covered?

Why We Are Out-of-Network

Many private practice therapists choose to be out-of-network for various reasons, often including:

• More flexibility in determining the course and length of treatment based on client needs rather than insurance company mandates.
• Reduced administrative burden, allowing more focus on direct client care.
• Greater privacy for clients, as less detailed information needs to be shared with insurance companies for routine billing.

We hope this information helps clarify how you might be able to use your out-of-network insurance benefits. While we don't handle direct insurance billing, we are committed to providing you with the necessary documentation to facilitate your reimbursement process. Please let us know if you have any questions.