I am an in-network provider with First Choice Health, and subsequently the Kaiser plans that contract with FCH for their behavioral health coverage (usually PPO plans). This means I have a contract with your health insurance company to accept a set fee for every session, and your health insurance pays the bulk of the therapy session fee. You are only responsible for paying the copay amount, or a deductible if that hasn’t yet been met.

PLEASE call your insurance to confirm I am in-network. Some Kaiser ID cards may say First Choice Health, but it’s coverage for a different service (emergency services, for example) instead of behavioral health. You can also use an app like Thrizer to check your benefits (see below).

That means I am an ‘out of network’ provider, and you will be responsible for payment of session fees (at my full rate, or if sliding scale, the rate we have discussed), instead of your insurance. I bill immediately following sessions, and provide you with a superbill, which you can use to get out-of-network reimbursement if you have out-of-network benefits.

An itemized receipt from a healthcare provider (me) that lists your information, diagnosis, and billing codes. If you have out-of-network benefits and would like to be reimbursed, your insurance will require this. I provide them following each session!

Here’s an example:

Let’s say you see me and pay $250 for your session. You submit a superbill to your insurance provider. Not all insurance plans have out-of-network benefits, but let’s say your plan covers 50% of out-of-network therapy. This means your insurance company might send you a check for $125. That means you only ended up paying $125 out of pocket.

It doesn’t happen overnight, but it can make therapy more affordable over time.

1. Call your insurance company to see whether you have out-of-network coverage for the specific therapy services you are seeking (outpatient mental health psychotherapy). If you have out-of-network coverage, proceed to step 2.

   [If this is too much of a hassle, you can also use Thrizer to check your benefits, which is an app that does all this for you. I am not affiliated with Thrizer, but have tried its benefits checker. Once you create a profile, you can check your benefits immediately.]

2. Ask your insurance company these questions:

   Is there an out-of-network deductible that needs to be met prior to getting reimbursed?

   If yes, how much is the out-of-network deductible? 

   What is the allowed percentage that will be covered by your insurance?

   How long is the reimbursement process?

   What is the process to file for reimbursement?

   Is there anything else I need to know?

You file for reimbursement on your own through your insurance. Typically this looks like logging into your client portal and filing a claim, which will require you to upload the superbill I have provided and/or to input the listed information.

Another option: there are apps, like Thrizer, who you may partner with to do all of this for you. They are designed to simplify all of your out-of-network claims, and take a small percentage of your reimbursement. You may learn more about that below.

There are services that streamline figuring out your out-of-network benefits as well as getting reimbursed for your therapy sessions through out-of-network benefits. They do this for a small fee ($2-$10/claim). One of these is Thrizer, and I have provided more information about them below. [DISCLAIMER: Dr. Kylie Niedermeyer, PsyD | Dream Wise Therapy is not affiliated with Thrizer. Use at your own risk]

Typically, you will have to call your insurance to verify your benefits, submit your superbills on complicated insurance portals, and then wait for a check in the mail.  With Thrizer, instantly verify your benefits on our portal, upload your superbills, and receive reimbursements directly to your bank account. We’ll handle the rest! 

https://www.thrizer.com/for-clients