Insurance
Why I don't bill insurance.
It's a fair question, and it deserves a straight answer rather than a line in the fine print. The short version: billing insurance would hand a third party real control over your diagnosis, your records, and how long you're allowed to keep coming. I'd rather that stayed between us. And you can still get reimbursed.
What insurance actually requires
To pay a claim, an insurer needs three things from your therapist: a billable mental health diagnosis, documentation proving that treatment is medically necessary, and the right to review your file to confirm both. None of those are optional, and all three have consequences.
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A diagnosis goes in your permanent record
Insurance can't pay for "I'm struggling" or "we keep fighting." It pays for a coded disorder. That code enters your medical record and your insurer's file, and it can surface later in life insurance underwriting, disability claims, some security clearances, and occasionally custody matters. Plenty of people want the help without the label following them around.
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Someone else decides when you're done
Insurers authorise a set number of sessions and can decline more if a reviewer decides you've improved enough. Attachment work doesn't run on that schedule. I'd rather we end therapy because you're ready than because a utilisation reviewer who has never met you said so.
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Your file stops being private
Accepting insurance means agreeing to audits. An insurer can request clinical notes to justify what they paid for. Without a claim, there's no reviewer, no audit, and nothing about your therapy sitting in a payer's database.
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Couples work usually isn't covered anyway
This surprises people. Most plans don't cover relationship therapy, because "our marriage is in trouble" isn't a medical diagnosis. To bill it, a therapist has to diagnose one partner with a disorder and frame the other as a participant in that person's treatment. I'm not willing to make one of you the patient to get a claim paid.
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The work stays aimed at what you came for
Grief, a hard transition, a pattern you want to understand, wanting to be a different kind of parent than the one you had: these are exactly what therapy is good for, and most aren't "medically necessary." Private pay means we work on what matters to you rather than what's reimbursable.
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A deliberately small practice
Insurance panels pay less per session, so in-network therapists carry larger caseloads to make the arithmetic work. I keep mine small on purpose. That means I have room to actually think about your case between sessions, rather than seeing you as the fifth hour of a nine-hour day.
You can still use your benefits
Not billing insurance is not the same as insurance being no help. If your plan includes out‑of‑network outpatient mental health benefits, which many PPO plans do, you can claim a portion back. It works like this:
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You pay me at the time of the session
Payment is due at the time of the session. The fee is the fee, with nothing hidden.
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I give you a superbill once a month
A receipt with everything an insurer needs: dates, service codes, my licence and tax details, and what you paid. You don't have to ask for it.
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You submit it to your insurer
Usually through their app or member portal, sometimes a form. It takes a few minutes.
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They reimburse you directly
Once your out-of-network deductible is met, plans typically pay back a percentage of what they consider an allowed amount. The cheque goes to you, not to me.
I can't promise what your plan will reimburse, and I'm not able to submit claims or appeal denials on your behalf. What I can do is give you a correct superbill, every month, without being chased for it.
How to find out what you'd get back
Call the member services number on the back of your insurance card and ask these, word for word. Write down the answers and the name of the person you spoke to.
- 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 this year?
- Once the deductible is met, what percentage do you reimburse for an out‑of‑network provider?
- What is your allowed amount for procedure code 90837? That's a 60‑minute individual psychotherapy session, and the percentage is paid on this figure, not on what I charge.
- Is pre‑authorisation required for out‑of‑network mental health?
- How do I submit a superbill, and what's the filing deadline?
- Is there a limit on sessions per year?
That last distinction catches people out, so it's worth repeating: if your plan reimburses 60% of an allowed amount of $150, you get $90 back per session once your deductible is met, regardless of the actual fee. Ask for the allowed amount, not just the percentage.
Your Good Faith Estimate
Because I'm a private‑pay practice, federal law under the No Surprises Act gives you the right to a Good Faith Estimate of what your care will cost, in writing, before we start. I provide one as a matter of course. You'll never find out what something costs after the fact here.