You found a therapist you want to work with and they are not in your network. Before you conclude it is unaffordable, check one thing: whether your plan has out-of-network benefits.
Many PPO plans do, and a substantial number of people pay full price out of pocket for years without ever submitting a claim, because nobody told them they could.
What a superbill is
A superbill is an itemized receipt formatted for insurance submission. You pay your therapist directly, they give you the superbill, and you submit it to your insurer for partial reimbursement.
It must contain:
- Your name and date of birth
- The provider's name, credentials, license number, NPI, and tax ID
- The practice address
- Dates of each session
- CPT codes — the procedure codes. For therapy these are typically 90791 for an initial diagnostic assessment, 90834 for a 45-minute session, and 90837 for a 60-minute session
- An ICD-10 diagnosis code
- The amount charged and confirmation that it was paid
Every element matters. A superbill missing an NPI or a diagnosis code will be rejected.
The diagnosis requirement, and what it means
This is the part people should understand before deciding.
Insurance reimburses treatment of a diagnosable condition. So a superbill carries a mental health diagnosis code, which becomes part of your insurance record.
For most people this is unproblematic. Health information is protected, and the days when a depression diagnosis routinely affected life insurance or employment are largely behind us for most purposes.
But it is a real consideration in specific situations — some security clearances, some professional licensing contexts, and certain insurance underwriting. If any of these apply to you, paying entirely privately without a superbill keeps the episode outside your insurance record.
It also means that if you are coming to therapy for something that does not constitute a diagnosable condition — general life coaching, personal growth, an ordinary rough patch — a diagnosis may not be appropriate, and no ethical clinician will invent one to enable reimbursement. That is insurance fraud, and it is worth knowing that a therapist who refuses is protecting you as much as themselves.
How to find out what you would get back
Call the number on your card and ask, in this order:
- "Do I have out-of-network outpatient mental health benefits?"
- "What is my out-of-network deductible, and how much of it have I met?"
- "After the deductible, what percentage do you reimburse?"
- "Is reimbursement based on my provider's actual charge or on an allowed amount?"
- "Is there a session limit?"
- "How do I submit a claim, and what is the deadline?"
- "Is telehealth covered out of network?"
Question four is the one that determines the real number. Many plans reimburse a percentage of an internal "allowed amount" rather than of what you actually paid. If your therapist charges $150 and the plan's allowed amount is $100 with 60 percent reimbursement, you receive $60 — 40 percent of what you spent, not 60.
Ask for a reference number and note the date and representative's name.
Submitting
Most insurers now accept claims through their member portal or mobile app, which is much faster than mail. You will typically upload the superbill and complete a member claim form.
Practical notes:
Submit monthly rather than saving them up. Deadlines are real, often 90 days to a year, and a stack of expired claims is a painful discovery.
Keep copies of everything.
Expect the first one to be rejected for something clerical. This is common and usually fixable — a missing field, a wrong form. Call and ask specifically what was wrong.
Reimbursement typically arrives in two to six weeks, as a check or direct deposit to you, not to your therapist.
Third-party services
Several companies will submit out-of-network claims on your behalf for a fee or a percentage. They can be worth it if the paperwork is the reason you would otherwise not submit at all. The math depends on your reimbursement rate and how much you value not dealing with it.
In-network is usually simpler
Worth saying plainly: if an in-network clinician is a good fit for you, that is generally the easier path. You pay a copay, the practice bills the insurer, and there is no paperwork and no waiting for reimbursement.
We are in network with most major plans, including Aetna, Cigna, Anthem Blue Cross Blue Shield, UnitedHealthcare, Health Plan of Nevada, and Silver Summit and Ambetter. For most people in Southern Nevada that means the simple route is available.
Where a client's plan is not one we contract with, we provide superbills on request, formatted with everything an insurer requires.
Nevada specifics worth knowing
Mental health parity is federal law: plans that cover mental health must do so on terms comparable to medical and surgical benefits — deductibles, copays, and visit limits cannot be more restrictive. If your plan treats therapy visibly worse than physical therapy, that is worth questioning, and the Nevada Division of Insurance handles consumer complaints.
Telehealth is covered by most Nevada plans, and a therapist must be licensed in the state where you are physically located during the session. Ours are licensed in Nevada, which covers you anywhere in the state.
Nevada Health Link plans, including Silver Summit and Ambetter, include behavioral health coverage.
The decision, simply
Use insurance if the cost difference matters to you and a diagnosis code in your record is not a concern. That is most people.
Pay privately if you want the episode entirely outside your insurance record, if you are not dealing with a diagnosable condition, or if you would rather not have any third party involved in decisions about your care.
Either is legitimate. What is not worth doing is paying full price for two years while sitting on an out-of-network benefit you never checked.
If you want us to check your specific coverage before you commit to anything, request an appointment and ask — we do the verification before your first session.