Super Billies
private practice
"out-of-network"
superbills
Private Practice
A long-standing tradition among therapy specialists.
Hidden Truths about Private Practice
There are several things that might surprise you about private practice therapists and other master’s level clinicians.
Mental health therapists are some of the lowest paid professionals in the US (among professions requiring master’s degrees). Therapists’ salaries average $30,000 to $50,000 below other professions. Many therapists who want to earn what they are worth head into private practice. There they can earn enough money to pay for their education, sustain a stable and growing private practice, and to hopefully self-actualize in their own lives the way they encourage their clients to do.
It's More than a Job.
To keep their licenses current, therapists must complete continuing education requirements. Depending on the state(s) where they are licensed, some therapists are required to complete 15-20 continuing education hours every year. Continuing education hours can cost up to several hundred dollars per hour (depending on the quality and level of instruction). Sadly, the less money a therapist has for continued education, the less they can invest in themselves and their clients.
The final thing you may not be aware of is, a “full-time” private practice therapist sees about 25 clients a week. While this may sound like a part time schedule, many therapists spend several hours each week outside of sessions managing their private practice and improving their skills (or they should be).
It's True, You Get What You Pay For.
The old adage “you get what you pay for” holds true, even in therapy. A therapist who is able to attend routine conferences, research their area of specialization, and spend time in supervision (processing what they are experiencing with their clients) are seeing better results in session than average therapists, and will need to charge clients more to cover these associated expenses.
Offsetting the cost of therapy for clients.
Out-of-Network
What is an "Out-of-Network" Provider?
An “out-of-network” provider has not entered into a contract with an insurance carrier to accept reimbursement for sessions, but they are vetted by and registered with insurance carriers so that clients may be reimbursed directly for services.
Unlike “in-network” providers, they have not agreed to accept an insurance carrier’s payment (along with the client’s copay/coinsurance portion) for sessions.
Unfortunately, one of the reasons that mental health therapists are among the lowest paid master’s level professionals is because of unfairly low reimbursement rates from insurance. Some therapists are accepting as little as $60 per session when “in-network.”
Managing Insurance Sucks.
In order to accept insurance as payment for sessions, many therapists find themselves going “in-network” with multiple carriers. This makes keeping up with filing claims, payments, claim denials, copays, shifting deductibles, and timely billing best suited for those in agency settings.
“Out-of-network” therapists are free to see clients as often as needed without interference or oversight from the insurance carrier, and offer clients a “superbill” for direct reimbursement.
Not only can the therapist work more freely and earn a commensurate rate, they are also saving thousands of dollars a year in noncollectable claim payments.
Superbills.
You may have money
waiting for you.
What is a Superbill?
A superbill is an itemized statement of your therapy sessions, and includes diagnostic codes, session billing codes, National Provider Identifier (NPI), tax codes, and office information.
The superbill shows what you were charged for the sessions and what you paid for the sessions. The document can be emailed to your insurance carrier for direct reimbursement.
How Much Will I Get Back?
Reimbursement rates vary greatly depending on the “out-of-network” benefits each carrier allows. But, many clients who use these benefits are happy with what they get back.
Get Ready to Call Your Insurance.
Be sure to have the following information on hand when you call the benefits number on the back of your insurance card.
- The therapist’s name and NPI (Troy Johnson, LCSW 1043623721)
- Your relationship to insured (spouse, partner, family)
- Member ID number and group number (on your insurance card)
- A diagnostic code that supports your need for therapy.
- F64.1 Gender dysphoria
- F43.12 PTSD
- F43.23 Adjustment disorder with anxiety and depression
- F41.1 Generalized anxiety disorder
- F33.1 Major Depressive Disorder
How Do I Verify My Benefits?
- Consult with Queer Talk for likely diagnostic codes and to see if they are “out-of-network” with your insurance (if you are unsure).
- Call the mental health benefits number on your insurance card and ask, “Do I have “out-of-network” mental health benefits?”
- Does my plan cover “out-of-network” therapy for codes 90791, 90837, and 90832?
- If yes, how many sessions are covered per year?
- If yes, do I have a deductible to meet? How much is the deductible?
- Does my “out-of-network” plan cover sessions for (appropriate diagnostic code).
- Do I need a pre-authorization, referral, or other documentation prior to my first session?
- Get the following information to document your call:
- Representatives name and ID number (if they have one).
- Reference number for the call.
- The date and time of your call.
- Document all of the above information for your records and peace of mind.
What Do I Tell My Therapist?
If you will be utilizing your “out-of-network” benefits, you only need to ask your therapist for the superbill, and make sure they are “out-of-network” with your carrier. At Queertalk, superbills are automatically generated and emailed to clients at the end of each month.
What if Queertalk is not registered with my carrier?
This happens. Sometimes it happens more than we want it to. Queer Talk is licensed in five states, and growing.
The truth is, there are hundreds of insurance carriers in these five states alone. Queer Talk is working diligently to get registered with as many common carriers as possible, but may ask for your patience.
If your insurance carrier is local, regional, small, or military related it may take longer for us to get registered.