Care at Stillpoint

Stillpoint Psychology is a private-pay practice and does not bill insurance directly. This allows therapy to remain fully confidential and focused on your individual needs without the restrictions that can accompany insurance-based care.

Many insurance plans offer out-of-network benefits that may allow you to receive partial reimbursement for therapy services.

If you plan to use out-of-network benefits, I can provide a superbill, which is a detailed receipt you can submit to your insurance company for possible reimbursement.

You can contact your insurance provider directly and ask about your out-of-network mental health benefits. Helpful questions to ask include:

• Do I have out-of-network benefits for psychotherapy?

• What percentage of the session fee is reimbursed?

• Is there a deductible that must be met first?

• Is there a limit on the number of sessions covered?

• What documentation is required for reimbursement?

You can usually find information about your mental health benefits by logging into your insurance provider’s member portal or by calling the customer service number listed on the back of your insurance card.

When reviewing your plan, look specifically for out-of-network mental health benefits, which may allow you to receive partial reimbursement for therapy services. If you have questions about how your benefits work, your insurance provider can help clarify your coverage.

These terms describe how insurance plans share the cost of healthcare services.

Copay:
A copay is a fixed amount you pay for a service (for example, $30 per therapy session).

Coinsurance:
Coinsurance is a percentage of the session cost that you are responsible for paying. For example, if your plan reimburses 60% of the fee, you would pay the remaining 40%.

Deductible:
A deductible is the amount you must pay out-of-pocket for healthcare services before your insurance plan begins reimbursing costs.

Because Stillpoint Psychology is an out-of-network provider, reimbursement will depend on the details of your individual plan.

A superbill is a detailed receipt for therapy services that includes the information your insurance company needs in order to process reimbursement.

If you plan to use out-of-network benefits, I can provide a superbill that you can submit directly to your insurance provider for possible reimbursement.

An Explanation of Benefits, often called an EOB, is a statement from your insurance company that explains how a claim was processed.

It typically includes information such as:

• The service that was provided

• The amount billed

• The amount your insurance covers

• The amount you may be responsible for paying

An EOB is not a bill, but rather a summary of how your insurance applied your benefits.

If you plan to use out-of-network benefits, it can be helpful to ask your insurance provider the following questions:

• Do I have out-of-network benefits for mental health services?

• What is my out-of-network deductible, and has it been met?

• What percentage of the session fee will be reimbursed?

• Is there a limit on the number of sessions covered per year?

• What is the reimbursement rate for the following services (CPT codes)?:

  • 90791 (Clinical intake)

  • 90834 (40 minute)

  • 90837 (60 minute)

  • 90847 (Couples therapy)

  • 90846 (Couples therapy when seeing one partner alone)

• Do I need preauthorization for therapy services?

• How do I submit a superbill for reimbursement?

• What documentation do I need to submit for reimbursement?

Your insurance provider can help you understand how your benefits apply to therapy services.

Private-pay therapy allows for a higher level of privacy, flexibility, and individualized care. Sessions are not dictated by insurance requirements, which means treatment can remain focused on your goals rather than insurance limitations.