Patient Resources
Out-of-Network Reimbursement: A Comprehensive Guide
Most patients receive 50–80% reimbursement from their insurer. Here's exactly how to get it.
Quick Summary
Integrative Psych is an out-of-network practice. We do not bill insurance directly, but we provide superbills after every appointment so you can seek reimbursement from your insurer. Many patients with PPO plans recover a significant portion of their session costs.
How Out-of-Network Reimbursement Works
When you see an out-of-network provider, you pay the provider directly. You then submit a claim to your insurer with a superbill. If your plan includes out-of-network benefits and your deductible has been met, your insurer reimburses you — typically by check or direct deposit — for a percentage of the “allowed amount.”
Plans vary widely in how they define the allowed amount and what percentage they reimburse. The steps below walk you through how to find out your exact benefits and maximize your reimbursement.
Step-by-Step Guide
Verify your out-of-network benefits
Call the member services number on the back of your insurance card and ask: “Do I have out-of-network mental health benefits?” Key questions: What is my out-of-network deductible? What percentage does the plan reimburse after the deductible? Is there a separate out-of-network out-of-pocket maximum? Does my plan use “usual and customary” rates or the full billed amount for reimbursement?
Understand the Mental Health Parity and Addiction Equity Act
Federal law (MHPAEA) requires that out-of-network mental health and substance use benefits be no more restrictive than out-of-network medical/surgical benefits. If your plan reimburses 80% for an out-of-network orthopedic surgeon, it generally must do the same for an out-of-network psychiatrist. If your insurer treats mental health differently, you have grounds to appeal.
Receive your superbill from us
After each appointment, you can download a superbill from the Patient Portal. A superbill is a detailed receipt that includes: the provider's NPI number, the procedure codes (CPT codes) for each service, the diagnosis codes (ICD-10), the date of service, the amount billed, and the provider's signature. This is the document your insurer needs to process a claim.
Submit the claim to your insurer
Most insurers have an online portal or a paper claim form (CMS-1500). You'll attach the superbill and submit it. Some insurers accept email submissions. Keep a copy of everything you submit and note the date. Claims are typically processed within 30–45 days.
Follow up and appeal if necessary
If your claim is denied, request the denial reason in writing. Common reasons include: services deemed "not medically necessary," out-of-network benefits not met deductible, or coding issues. You have the right to a first-level appeal, and in many states an independent external review if the internal appeal fails. Contact our billing team — we can provide documentation to support your appeal.
Tip: Use a reimbursement service
Services like Reimbursify and Nirvana Health can submit claims on your behalf for a small fee — often worth it to avoid the administrative burden. Ask our team for recommendations.
Frequently Asked Questions
How much can I expect to be reimbursed?+
This depends entirely on your specific plan. Many PPO plans with out-of-network benefits reimburse 50–80% of the "allowed amount" after the out-of-network deductible is met. HMO plans typically do not cover out-of-network care except in emergencies. Call your insurer to get your exact benefit percentages.
What is the difference between in-network and out-of-network?+
In-network providers have a contract with your insurer and accept a negotiated rate. Out-of-network providers (like Integrative Psych) set their own fees, and your insurer reimburses you a portion after you submit a claim. Out-of-network care gives you access to providers not in your insurer's directory.
Why doesn't Integrative Psych accept insurance directly?+
Accepting insurance directly would require us to accept significantly reduced rates that would limit the time and depth of care we can offer each patient. Operating out-of-network allows us to maintain longer appointments, more comprehensive evaluations, and a lower patient load — which translates to better care.
Can I use my HSA or FSA to pay for sessions?+
Yes. Mental health appointments are qualified medical expenses under HSA and FSA rules. You can use pre-tax HSA or FSA dollars to pay for our services directly — whether or not you also seek insurance reimbursement.
What if my insurer denies my claim?+
Don't give up. Request the denial reason in writing, then file a first-level internal appeal. Include a letter from your clinician documenting medical necessity if the denial is based on that reason. If the internal appeal fails, request an independent external review. Many claims are successfully overturned on appeal.
Ready to get started?
Have questions about insurance or billing?
Our team is happy to help you understand your benefits and walk through the reimbursement process before your first appointment.