Insurance 101: Understanding Therapy Coverage & Key Terms
Navigating insurance for therapy can feel overwhelming, especially if it’s your first time exploring mental health benefits. At Pulianda & Brock Psychology Associates, we believe that understanding your insurance options empowers you to make informed decisions about your care.
Whether you’re planning to use in-network benefits or seek reimbursement for out-of-network services, here’s a simple guide to help you understand common insurance terms and how they apply to therapy.
In-Network vs. Out-of-Network
In-Network: Your therapist has a contract with your insurance company. You’ll typically pay a lower out-of-pocket cost (copay or coinsurance) because your plan covers more of the fee.
Out-of-Network: Your therapist does not have a contract with your insurer. You pay for sessions in full and may be able to submit a superbill (a detailed receipt) to your insurance company for possible partial reimbursement.
We currently accept Blue Cross Blue Shield and Aetna insurance plans.
Key Insurance Terms You Should Know
Deductible
Your deductible is the amount you must pay out-of-pocket for covered healthcare services before your insurance plan starts to share the cost.
Example: If your deductible is $1,000, you must pay $1,000 toward covered services before your insurance will begin paying its portion.
This means that even if your therapist is in-network, you may be responsible for the full session fee until your deductible is met.
Superbill
A superbill is a detailed invoice that includes information your insurer needs to process an out-of-network claim. You submit it to your insurance company to request reimbursement.
CPT Code
A CPT code is a standardized number used by insurance companies to identify the type of service provided. For example:
90837.95 = Individual psychotherapy (telehealth)
90847.95 = Couples/family therapy (telehealth)
Usual & Customary Rate (UCR)
The maximum fee your insurance company considers standard for a service in your geographic area. If your therapist charges more than the UCR, you may be responsible for the difference.
Prior Authorization
Some insurance plans require you to get approval before starting therapy sessions. This is called prior authorization and is important to confirm before booking.
Good Faith Estimate (GFE) & No Surprises Act
If you are uninsured or not using insurance, you have the right to receive a Good Faith Estimate of the expected cost of your care.
Our Session Fees
Free 15-minute phone consultation
Initial Intake (50 min): $225
Regular Session (50 min): $195
If you are out-of-network, we will provide you with a superbill so you can request reimbursement from your insurance company.
Questions to Ask Your Insurance Company
When calling your insurer, it helps to have these ready:
Do I have out-of-network mental health benefits?
What is my deductible, and how much of it have I already met?
What is my copay or coinsurance once my deductible is met?
What is the Usual & Customary Rate for CPT code 90837 in my area?
Do I need prior authorization before starting therapy?
Are there any session limits per year?
Final Thoughts
We know that insurance can be confusing, but you don’t have to figure it out alone. We’re happy to guide you through the process, help you understand your benefits, and ensure there are no surprises when it comes to your therapy investment.
If you have questions or want to discuss your options, schedule your free 15-minute consultation with us today.
