Private Pay Therapy? Here’s How to Actually Get Reimbursed From Your Insurance
Private pay therapy often gets a reputation for being expensive, inaccessible, or only for people who have premium insurance plans. The truth is much more encouraging. According to the National Association of Insurance Commissioners, more than 60 percent of employer-sponsored insurance plans offer some form of out-of-network mental health coverage, and many reimburse between 40 percent and 80 percent of the session fee depending on the plan.
In other words, private pay is not always a financial dead end. You may simply need a roadmap for how to use your benefits correctly. Below is a clear, step-by-step guide that helps clients get reimbursed more efficiently, avoid common delays, and maximize what their insurance already offers.
Why Insurance Reimbursement Exists in the First Place
The Mental Health Parity and Addiction Equity Act requires most insurance plans to provide mental health benefits at the same level as physical health. This includes out-of-network coverage. Yet a 2023 survey by KFF found that about 45 percent of patients do not understand their mental health benefits well enough to use them. As a result, millions leave reimbursement dollars unused.
This blog post helps you avoid that mistake.
Step 1: Check Your Out-of-Network Benefits
Most insurance cards list an 800 number for behavioral health. Call the number and ask the following questions:
Do I have out-of-network mental health coverage for outpatient therapy?
What is my reimbursement rate for CPT codes 90791 and 90837?
Is there a deductible for out-of-network care, and how much of it has been met this year?
Do I need preauthorization for psychotherapy services?
Where do I submit my superbill?
💡 Takeaway: Most clients discover that reimbursement starts after the deductible is met. If you are early in the year, ask how close you are.
Step 2: Ask Your Provider for a Superbill
A superbill is the document insurance companies require to reimburse you. It includes:
Diagnosis code
CPT service code
Provider license information
Session date and fee
Proof of payment
According to a 2022 Health Affairs study, claims submitted with complete documentation are processed 32 percent faster and have a higher approval rate. Palm Atlantic Behavioral Health provides detailed superbills that meet insurer requirements to make the process smoother.
Step 3: Submit Your Superbill Correctly
Most insurance companies accept superbills through:
Secure online portals
Email to the claims department
Fax submission
Dedicated mobile apps
Do not skip this step: Save all confirmations or submission receipts. Many insurers take 30 to 45 days to complete reimbursement.
Step 4: Track Your Claims
If you do not receive a response in 30 days, call to confirm processing. A study published in the Journal of Health Economics found that claim denials are often caused by minor clerical errors, not policy restrictions. Problems like a misspelled name or incorrect birth date can stall payments unnecessarily.
💡 Takeaway: Set a calendar reminder to follow up. A five-minute call can save weeks of waiting.
Step 5: Appeal If Needed
Insurance companies occasionally deny claims for reasons that have nothing to do with your benefits. You have the legal right to appeal.
Common appealable reasons include:
Incorrect coding entered by the insurer
A misunderstanding of diagnosis
Request for additional documentation
PABH can provide any additional paperwork you need to help your appeal succeed.
Why Clients Choose Private Pay First
People often choose private pay for:
Faster access to care
The ability to choose a therapist who specializes in specific needs
Reduced insurance restrictions
When combined with out-of-network reimbursement, private pay becomes a practical and powerful option.
Final Takeaway
Private pay therapy is not always as costly as it appears. With the right knowledge and tools, many clients recoup a significant portion of their investment in mental health care. At Palm Atlantic Behavioral Health, we guide you through every step, from generating a superbill to helping you communicate with your insurer.