Out-of-network therapy in Washington, explained

What out-of-network actually means

I'm a private-pay therapist, which means I don't bill insurance companies directly. You pay my fee at the time of each session, and I give you a document called a superbill that you can submit to your insurer for reimbursement. If your plan includes out-of-network (OON) mental health benefits, your insurer sends money back to you, not to me.

Why work this way? Because it keeps our work between us. No insurer decides how many sessions you get, requires a diagnosis on file to approve care, or reviews what we talk about. It also means I have openings when in-network therapists have months-long waitlists.

The numbers

• My fee: $150 per 50-minute session, paid at the time of service. I accept major credit cards, and HSA and FSA cards.
• Free 15-minute consultation before we begin, so you can decide whether we're a fit.
• Typical reimbursement: plans with OON benefits commonly cover somewhere between 50% and 80% of what they consider the "allowed amount" for a therapy session, after you've met your OON deductible. Every plan is different, which is why the phone call below matters.

Clients have successfully used OON benefits from Premera Blue Cross, Regence and other Blue Cross Blue Shield plans, Cigna / Evernorth, Providence, and Kaiser (PPO plans with OON coverage). Whether your specific plan reimburses, and how much, depends on your deductible and your plan's terms.

How to check your benefits in one phone call

Call the member services number on the back of your insurance card and ask these questions. Write down the answers and the name of the person you spoke with.

1. "Do I have out-of-network benefits for outpatient mental health?" If the answer is no (common with HMO and some EPO plans), reimbursement won't be available, and you'll want to weigh the fee on its own terms.
2. "What is my out-of-network deductible, and how much of it have I met this year?" Reimbursement usually begins only after this is met. Some plans have a separate, higher OON deductible; some count in-network spending toward it.
3. "What percentage do you reimburse for CPT code 90837 (a 53+ minute psychotherapy session), and what is the allowed amount?" The allowed amount is what they consider a fair price, and the percentage is applied to that, not necessarily to my full fee.
4. "Do I need pre-authorization, and how do I submit a superbill?" Most plans accept superbills through an online member portal or a claim form. Ask for the link or the mailing address.

What a superbill is, and what I provide

A superbill is an itemized receipt with everything an insurer needs to process a claim: my name, license, and NPI number, the date and length of each session, the service code (usually 90837 for a full session), a diagnosis code, and the amount you paid. I send one at the end of each month for the sessions you've had. You submit it to your insurer; they process it and, if you're eligible, mail you a check or deposit the reimbursement.

Two honest notes. First, a superbill has to include a diagnosis code, because insurers require one to reimburse. We'll talk about what that means for you before I issue anything. Second, reimbursement isn't instant; four to eight weeks is typical. Some people use a claims app to track submissions, but a plan's own portal works fine.

What you'll know before we start

Under the federal No Surprises Act, private-pay clients are entitled to a Good Faith Estimate of expected costs. I provide one before your first full session, and I'll update it if anything about our work changes. There are no hidden fees. My cancellation policy is in the intake paperwork you'll receive before we begin, and I'm glad to go over it on the consultation call.