How to Get Reimbursed for Therapy and Psychological Testing
So you paid for therapy or psychological testing out of pocket?
5 Pro Tips For Reimbursement:
Finding the right fit for therapy and psychological testing can be challenging. After an endless number of calls to find someone in-network who is available and specializes in what you’re looking for, families often feel like an out-of-network provider is the only option. Many families end up paying for therapy, testing, or other services themselves, out of pocket, in order to find the best provider, or even any provider. This can be a big financial burden. But there is good news—you may be able to get some of that money back!
Why Reimbursement Matters
Mental health care is expensive. Therapy sessions can cost over $200 each. Psychological testing and evaluations may be even more costly, because of the greater amount of time and work involved for the provider. Insurance companies often say they cover mental health care. But finding an in-network provider who fits all of your needs can be tough! Paying out of pocket is sometimes the only choice.
Reimbursement can help. It means your insurance pays you back for some of the money you spent. While it may not cover everything, it can make a big difference. But getting reimbursed takes effort. You need to know the process and follow the right steps.
Step 1: Check Your Insurance Plan
Before you pay for a service, check your insurance benefits. Look for a section called "out-of-network benefits." If your plan offers this, you may be eligible for reimbursement.
Call the number on your insurance card to ask:
Does my plan reimburse for out-of-network mental health therapy and psychological testing? Ask the provider for the “CPT codes” for the services. The insurance company will probably want to know what codes will be used for a claim.
How much will I get back?
When the answer is a percentage (say 50%), ask what is the “usual and customary” rate. The insurance company will pay that percentage of that rate (not what the provider charges per session).
Ask if there is a deductible to be met before payment will be made. The deductible will be calculated at the “usual and customary” rate per session (not what the provider charges).
Are there any limits on the number of sessions or types of testing? What if we complete testing but do not end up with a diagnosis?
Do I need pre-approval?
What paperwork is required?
Write down the answers you receive. Keep your own notes carefully organized with dates, details, the reference number from the call, and the name of the representative with whom you spoke. It’s too much to try to remember yourself. Recording these details will help you understand and keep track of what to expect.
Step 2: Submit a Claim to Your Insurance
Once you have the necessary documentation from the provider, you need to send it to your insurance company. Most insurers let you submit claims online, by mail, or through an app.
Follow these steps:
Fill out a claim form (find it on your insurer’s website or ask customer service). Be sure to fill it out accurately and completely.
Attach the necessary documentation, usually called a “superbill” from the provider.
Include any other required documents.
Submit the claim and save a copy for your records.
Step 3: Follow Up
Insurance companies can take weeks to process claims. Check the status of your claim online or call customer service. If it’s denied, ask why. Sometimes, small mistakes cause denials. Small details can be enough to cause a rejection. So, being accurate and complete is essential. You may need to resubmit or provide more details.
If you don’t get a clear answer, ask to speak to a supervisor. Be patient (and polite) but persistent. Keep track of who you talk to and what they say. Supervisors are often not immediately available, but they are often more knowledgeable and helpful. Ask the supervisor, or a helpful processor, for a direct phone line to reach them, if you can get it, so if you have to call back you can ask for that person more easily. Going through the “phone tree” to get to a live person can be time consuming and frustrating.
Step 4: Appeal if Necessary
If your claim is denied, don’t give up. You can appeal the decision. Ask your insurance company how to start an appeal.
In many cases, you will need:
A letter from the provider explaining why you need the therapy or psychological testing.
A cover letter from you detailing all the steps you have taken, including who you have spoken to and when.
Copies of previous claims and denials.
Appeals take time, but they can work. Many denials are overturned after an appeal. This can take considerable time and persistence.
Step 5: Look for Other Reimbursement Options
If your insurance doesn’t cover out-of-network therapy or psychological testing, there may be other options:
Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA): If you have one of these accounts, you can use it to pay for mental health services with pre-tax dollars.
Sliding Scale Fees: Some providers offer lower fees based on your income or financial circumstances.
Grants and Assistance Programs: Some nonprofit groups help cover mental health costs.
Employer Benefits: Some workplaces offer reimbursement programs for therapy and testing.
Tips to Maximize Reimbursement
Stay Organized: Keep copies of all bills, claim forms, and insurance statements.
Keep Notes of all your contacts with the insurance company.
Submit Claims in a timely way: Many insurance companies have deadlines for claims.
Check Your Plan Regularly: Insurance benefits change, often with each enrollment period. Make sure you know your coverage.
Advocate for Yourself: If you get denied, keep pushing for answers and reconsideration.
Navigating insurance reimbursement can be frustrating, but with persistence, organization, and self-advocacy, you can increase your chances of getting reimbursement—making mental health care a little more accessible and affordable.
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Our Services:
Child Psychology Center offers neuro-affirming, culturally competent, evidence-based therapy for children (ages 0+), teens and caregivers. We offer virtual therapy for people throughout all of California, and we offer in-person therapy near San Diego (in Carlsbad, CA) and San Francisco (in Folsom, CA). Our services are available in both English and Mandarin. Our licensed psychologists offer psychological assessments. While our therapists specialize in treating children, we also treat adults. We specialize in treating anxiety, child behavioral problems, obsessive compulsive disorder (OCD), ADHD, Autism, and Post-Traumatic Stress Disorder (PTSD). We offer parent coaching and consultation. We would love to support you along your journey. Reach out for a free 15-minute consultation today!
