Payment · Maryland telehealth
Out-of-network benefits, explained plainly.
How out-of-network mental health benefits and itemized superbills actually work. The practical mechanics, without the jargon.
Hélène Ndoye Diop, LCPC is in-network with CareFirst BlueCross BlueShield, Aetna, BlueCross BlueShield of Massachusetts, Kaiser Permanente of the Mid-Atlantic, and Providence Health Plan. Sessions under those plans are billed directly to the carrier, and clients pay their plan's copay or coinsurance at the time of service.
For clients whose plan is not on that list, C-G Health operates as an out-of-network practice. Payment is due at the time of service, and an itemized statement (commonly called a superbill) is provided for clients who wish to submit for reimbursement through their health plan's out-of-network mental health benefits.
The rest of this page describes how the out-of-network process works in plain terms, for the clients it applies to. Whether in-network or out-of-network, a short call to your carrier before starting is worthwhile: it helps confirm coverage, your deductible, and reimbursement details.
What a superbill is
A superbill is an itemized statement of services rendered. It includes the provider's name, licence number, and tax ID, the dates and lengths of the sessions attended, the appropriate diagnostic code, the CPT service code (typically 90837 for individual sessions or 90847 for couples), and the amount paid.
That single document contains everything a health plan needs to process an out-of-network reimbursement request. Superbills are provided monthly on request, at no additional charge, and can also be produced for a specified date range at any time.
How out-of-network reimbursement works
Many commercial health plans include a set of benefits for out-of-network mental health care. When a client sees a provider who is not in-network for their plan, the client pays the provider directly, submits the superbill to the insurer, and, if the plan has out-of-network mental health coverage, the insurer reimburses the client for a portion of the fee, usually after an out-of-network deductible has been met.
The amount reimbursed varies significantly by plan. Some plans reimburse a percentage of a set 'allowed amount', which may be less than the actual session fee. Others have a flat allowance per session. Some plans have very generous out-of-network benefits; some have none at all.
Questions worth asking your insurer
Before assuming what your plan will cover, a short call to the member-services number on the back of your insurance card is worth its weight. Useful questions to have ready:
Does my plan include out-of-network mental health benefits? What is my out-of-network deductible for mental health, and how much of it have I met this year? What percentage of the 'allowed amount' does the plan reimburse for CPT code 90837 (individual, 53–60 minutes) and 90847 (couples, 50+ minutes)? Is there a session limit per calendar year? How do I submit a superbill for reimbursement, and how long does processing take?
Answers to those questions give a realistic picture of what a course of therapy will cost you after reimbursement, and let you plan accordingly.
Federal price transparency: the Good Faith Estimate
Under the federal No Surprises Act, any client not using health insurance to pay for services is entitled to a written Good Faith Estimate of expected charges for a course of care. C-G Health provides that estimate at the start of the therapeutic relationship, on request, and any time a client asks.
About HSA and FSA
Psychotherapy is a qualifying medical expense for Health Savings Accounts and Flexible Spending Accounts. Sessions can be paid for using an HSA or FSA card directly, and superbills can be submitted to the account administrator if additional documentation is needed.
Is this a fit?
An honest word about the work.
You'll likely get the most from this work if you are:
- Adults across Maryland whose plans include out-of-network mental health benefits
- Clients paying privately who value the confidentiality and clinical freedom out-of-network work allows
- People using HSA or FSA funds for mental health care
The work asks for:
- Willingness to pay for sessions at the time of service and submit for any reimbursement yourself
- A short phone call to your insurer to understand your specific benefits
- Comfort with a straightforward monthly billing rhythm
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