How much does therapy cost

$125–$175 per 50-minute session
(Fee varies by clinician experience)

How do people pay for service

Self-Pay (Most Common)
You pay directly at the time of service.
✔ Predictable costs
✔ No insurance restrictions
✔ Greater privacy

Out-of-Network Reimbursement
Many clients submit claims to their insurance for partial reimbursement.

You can pay using your credit card, HSA, or FSA account. Healthcare costs may be tax deductible. So, be sure to ask for your payment statements for additional savings.

Link for questions or help.

Insurance Reimbursement Guide

Understanding Out-of-Network Benefits

Navigating insurance benefits can often feel confusing and overwhelming. At Sound Mind Therapy, it is understood that the cost of therapy is an important consideration when seeking care.

Although Sound Mind Therapy does not bill insurance directly or participate as an in-network provider, many insurance plans offer reimbursement for out-of-network mental health services. Depending on the individual policy, clients may be eligible to receive reimbursement for a portion of the fees paid for therapy.

This guide is designed to help clients better understand their insurance benefits, ask the right questions, and feel more informed throughout the reimbursement process.

Contacting Your Insurance Company

Clients are encouraged to contact the Member Services or Benefits Department using the phone number listed on the back of their insurance card before beginning services.

When speaking with an insurance representative, it is recommended to:

• Write down the name and extension of each representative.
• Keep detailed notes of every answer provided.
• Ask for clarification if any information is unclear. Insurance terminology can be complex, and representatives should be able to explain benefits in understandable language.
• Request to speak with a supervisor if answers seem inconsistent or incomplete. Maintaining accurate records can be helpful should questions arise later.

Understanding How Reimbursement Works

Out-of-network reimbursement varies by insurance company and individual policy.

Some insurance plans reimburse a percentage of the actual amount paid for therapy. For example, if an individual therapy session costs $125 and the plan reimburses 80%, the client may receive $100 back after any applicable deductible has been met.

Other insurance plans reimburse based on what they refer to as the “allowed amount.” In this case, the insurance company determines the maximum amount they recognize for a particular service, regardless of the actual fee charged.

For example:

• Therapy session fee: $125
• Insurance company’s allowed amount: $60
• Reimbursement rate: 80%

The reimbursement would be $48, not 80% of the full session fee.

If the insurance representative is unable to provide the allowed amount for CPT Code 90837, clients are encouraged to request this information from a supervisor, as it is an important factor in estimating out-of-pocket costs.

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Questions to Ask Your Insurance Company

When contacting the insurance company, the following questions may be helpful:

1. What is the representative’s name and extension number?
2. Does the policy include out-of-network mental health benefits?
3. Are services provided by a Licensed Clinical Social Worker (LCSW) covered under the plan?
4. Will the insurance company accept a superbill that includes session dates, diagnosis, CPT code, and payment information for reimbursement?
5. Is CPT Code 90837 (60-minute individual psychotherapy) covered?
6. Are there any mental health diagnoses that are excluded from reimbursement?
7. How many therapy sessions are covered each calendar year?
8. Is there a lifetime maximum for mental health benefits?
9. What is the client’s out-of-network deductible?
10. What is the insurance company’s allowed amount for CPT Code 90837? (The current session fee at Sound Mind Therapy is $125.)
11. What percentage of the allowed amount is reimbursed once the deductible has been met?
12. What is the process for submitting claims? Can claims or superbills be uploaded electronically?

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Important Considerations

Insurance reimbursement often changes throughout the year based on deductibles, plan limits, and policy requirements.

Clients should keep the following in mind:

• Reimbursement may not begin until the out-of-network deductible has been satisfied.
• Most insurance plans reset deductibles at the beginning of each calendar year, which may temporarily increase out-of-pocket expenses.
• Some plans limit the number of therapy sessions eligible for reimbursement each year.
• Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) may be used to pay for therapy with pre-tax dollars, depending on the individual’s plan.
• Clients may wish to consult with a tax professional regarding potential deductions for qualified medical expenses, including psychotherapy.
• During insurance open enrollment, plans with out-of-network mental health benefits (such as many PPO plans) may provide greater reimbursement flexibility for therapy services.

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Superbill Information

Upon request, Sound Mind Therapy is happy to provide clients with a superbill that includes the information typically required for insurance reimbursement, including:

• Dates of service
• CPT (procedure) codes
• Diagnosis code
• Provider credentials and National Provider Identifier (NPI)
• Amount paid

While Sound Mind Therapy strives to provide all necessary documentation, reimbursement decisions are made solely by the client’s insurance company. Coverage, reimbursement rates, deductibles, and claim requirements vary by plan.

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Supporting Your Investment in Therapy

At Sound Mind Therapy, the focus is on providing personalized, high-quality care without the limitations that often accompany insurance participation. While navigating insurance can sometimes be frustrating, many clients find that using their out-of-network benefits allows them to receive reimbursement while maintaining greater flexibility and privacy in their care.

If questions arise regarding superbills or the reimbursement process, Sound Mind Therapy is happy to assist in providing the documentation needed to help clients submit their claims with confidence.