What are the benefits to cash-pay (with available superbill), as opposed to billing directly to insurance? (provider-to-patient billing)
No therapy records sent to insurance companies
No permanent mental health diagnosis in insurance databases
No shared treatment notes
No third-party access to session content
No session caps (seen most frequently with EAP's)
No arbitrary discharge requirements
No interruption due to insurance or network changes
Clients choose reimbursement path
Flexible financial planning
Transparent pricing
Clear expectations
What are the drawbacks to utilizing insurance? (provider-to-insurance billing)
Session notes (your personal mental health information) is shared with third parties
Diagnoses become permanent insurance records and can follow you indefinitely
Treatment options may be restricted
Sessions may be limited or interrupted
Care decisions may be influenced by non-clinical entities
Privacy and autonomy may be reduced
A superbill is an itemized receipt that a client can submit to their insurance company for possible out-of-network reimbursement. It typically includes:
Provider name and credentials (including NPI #)
Practice information
Client name
Date of service
CPT codes
Diagnosis codes
Fee paid
Superbills can be provided at either the time of service, or on a monthly/scheduled basis. Checking to see if your insurance provider accepts a superbill is as easy as calling the number on the back of your insurance card.
PPO (Preferred Provider Organization) Plans
PPO plans typically allow out-of-network coverage (including outpatient psychotherapy) after the member meets a deductible. These plans usually reimburse a portion of the billed charge (e.g., 50–80% of UCR — usual, customary, and reasonable — rates) after deductible. Many major carriers in NH offer PPO options that include this benefit.
POS (Point-Of-Service) Plans
POS plans may also provide out-of-network benefits, though often with higher cost sharing than PPO plans.
HMO and EPO Plans do not typically include out-of-network coverage, and operate exclusively with contracted providers.
In order for any licensed mental health provider to bill directly to insurance, he/she must first be credentialed with the insurance carrier. Depending on the carrier, credentialing in itself is often a lengthy and cumbersome process, and typically requires an extended period of time for the carrier to process the application prior to approval.
When a provider is credentialed (in-network) it means there is an agreed upon contract with the insurance carrier, which includes fixed rates for different types of services (i.e. a 50 minute psychotherapy session). The rate of reimbursement for services varies from carrier to carrier.
Reimbursement rate, credentialing length, and other items (such as frequency of audits, likelihood of a clawback, payout cycles, etc.) all factor into whether a provider will accept an insurance type.
Not finding the answer to your question here? Email me directly: david@hutchingspsychotherapy.com