Out-of-network therapy and superbills

Melanie is out-of-network with all insurance plans. There is no billing relationship between her practice and your insurer, so you pay the full fee directly and anything that comes back to you happens afterward, between you and your plan. Individual psychotherapy is $235 for a 50-minute session, usually weekly. There is no sliding scale.

A superbill is an itemized receipt for services you have already paid for. It lists what took place so your insurance company can decide what, if anything, to reimburse under your out-of-network benefits. Melanie provides one monthly. With a superbill, the person who submits it is you, on your plan's timeline and through your plan's process.

Call the member services number on your card and ask about out-of-network outpatient mental health benefits, in those words. Ask whether you have them at all, what your out-of-network deductible is, and how much of it you have met this year. Ask what percentage of the allowed amount comes back to you once the deductible is met, and what your plan treats as an allowed amount for a 50-minute individual session. Ask whether preauthorization is required, whether there is a visit limit, how superbills should be submitted, and what the deadline for submitting one is. Write down who you spoke to and when, because plans have been known to answer the same question two different ways.

A Good Faith Estimate is a written estimate of what your care is expected to cost when you are not going through insurance. One is available on request. An estimate is a projection made at a point in time, not a bill and not a ceiling. If your circumstances change, ask for an updated one.

Individual psychotherapy is $235 per 50-minute session. Ketamine-assisted therapy is separate: a 180-minute session at $846, in person at Melanie's Manhattan office or in your home. The prescribing, screening and oversight for that work belong to a separate independent licensed medical provider and never to her, and she does not prescribe, supply or administer medication. It is not a first-line treatment, and it is offered only alongside ongoing psychotherapy with her. Cancellations and reschedules need 24 hours' notice, and inside that window the full fee applies.

Everything above describes how out-of-network benefits usually work. It is not insurance advice and it is not a reading of your particular plan. Your plan document and your insurer are the only authorities on what your plan covers. Reimbursement is never guaranteed, and some plans reimburse nothing at all.