How to Use Out-of-Network Benefits to Invest in Private Therapy for Your Teen

By: Miguel E. Brown M.S.Ed., LMFT

As a parent, you want the absolute best for your teenager, especially when it comes to their mental health. For many families in Miami, that means seeking out a private, specialized therapist.

I made the deliberate choice to run a private-pay pract

ice at Miami Teen Counseling because I believe your teenager’s care shouldn't be dictated by an insurance company. When we work outside the insurance system, there is no mandatory mental health diagnosis placed on your child’s permanent medical record. I don't have to justify session limits to a claims adjuster, and we have the flexibility to tailor the treatment entirely to what your teen actually needs.

However, I also know that private psychotherapy is a financial investment.

The good news is that you don't always have to choose between high-quality, confidential care and getting help to pay for it. If you have a PPO insurance plan, you likely have Out-of-Network (OON) benefits that can reimburse you for a significant portion of our sessions.

Here is exactly how you can use those benefits through a process called "superbilling," and how to get started.

What is a Superbill?

A superbill is simply a specialized, itemized receipt that I provide to you at the end of each month. It contains all the specific medical coding that your insurance company requires to process a healthcare claim.

Instead of me billing your insurance company directly (which requires a contract and loss of confidentiality), you pay for the session at the time of service. At the end of the month, you take the superbill I give you and submit it to your insurance company. They will process the claim and mail a reimbursement check directly to you.

Depending on your specific plan, insurance companies typically reimburse anywhere from 50% to 80% of the session cost once your out-of-network deductible has been met.

How to Get the Process Started

Insurance companies won't volunteer this information, so you need to be proactive. Before our first session, call the customer service number on the back of your insurance card and ask them these exact questions:

• "Do I have out-of-network benefits for outpatient mental health services?"

  
  

• "What is my out-of-network deductible, and how much of it have I already met this year?"

  
  

• "What is my reimbursement rate (percentage) once my deductible is met?"

  
  

• "What is the 'Usual, Customary, and Reasonable' (UCR) rate you allow for CPT codes 90791 and 90837?" (These are the standard billing codes for an initial intake evaluation and a standard 60-minute therapy session, respectively).

  
  

• "Is any prior authorization required before we begin treatment?"

  
  

Write down the date, time, and the name of the representative you spoke with. Having a paper trail is always a good idea when dealing with insurance.

3 Tips for Working with Your Insurance Company

1. Submit Consistently: Don't wait until the end of the year to submit a massive stack of superbills. Most insurance companies have time limits on filing claims (sometimes as short as 90 days). Submit your superbills monthly to ensure a steady stream of reimbursement and to catch any processing errors early.

   
   

2. Use Claims Apps: If navigating your insurance company's online portal feels overwhelming, look into apps like Reimbursify. For a small fee, you just take a picture of the superbill on your phone, and the app files the out-of-network claim for you and tracks its progress.

   
   

3. Understand the "Allowed Amount": When an insurance rep says they reimburse 70%, that means 70% of their maximum allowed rate (the UCR), not necessarily 70% of my exact fee. Getting clarity on their UCR rate during your initial phone call will help you budget accurately.

   
   

The Bottom Line

Dealing with insurance takes a little bit of legwork up front, but it is often highly worth it. Using your out-of-network benefits allows you to maintain the superior privacy, flexibility, and personalized focus of private therapy, while still utilizing the healthcare coverage you already pay for.

If you are ready to invest in professional, private support to help your teenager build resilience and self-awareness, request an initial consultation today. I am always happy to answer any questions about how this process can work for your family.