Out-of-network provider for psychotherapy: California and Colorado

Some insurance providers will offer reimbursement for psychotherapy (50-100% of the fee). If this is an option for you, I can provide a superbill to submit your claim. Because insurance reimbursements require a diagnosis and treatment code, these items will be listed on your superbill. Reach out to your insurance provider to inquire about reimbursement for out-of-network psychotherapy providers.

You can typically find the “member services” number on the back of your insurance card.  Here are some questions you may ask:
“Does my plan include out-of-network benefits for mental health services or outpatient psychotherapy?”
“Does my plan set limits on the number of sessions per calendar year?”
“Does my plan have a deductible for out-of-network mental health services? If so, how much do I need to pay before my plan will reimburse me for any session fees I pay out of pocket? What is my copay for a 50-minute psychotherapy session after I meet my deductible?"

It is the responsibility of the client to determine if they are eligible for full or partial reimbursement for their out-of-network mental health services. If you do have reimbursement benefits, you are responsible for paying the full session fee at the time of the session, and then you may submit a claim to your insurance following the session.

Deborah Griffith Runs a portion of her practice through Octave, which accepts the following insurance plans (inquire about available slots):

  • Aetna

  • Anthem Blue Cross of California

  • Blue Shield of California

  • Out of State Blue Card

  • Cigna/Evernorth

These insurance networks can be billed directly for 50-minute psychotherapy sessions with a diagnosis present. You are responsible for the associated co-pay amount at the time of the session. Co-pay amounts range based on insurance company and plan, but are usually a small percentage of the overall fee.

FAQs

  • No, unfortunately these offerings are not billable to insurance and are only available via out-of-pocket private pay. Only 50-minute, weekly sessions with a diganosis present are billable to insurance

  • Sessions billed to insurance are 50 minutes long.

    Longer sessions of 90 minutes, intensives of 3 hours or more, or other individualized requests may be available but fall under out-of-pocket private pay requirements.

  • Yes. Evidence suggest reliability of therapeutic assessment, efficacy of treatment, and statistically equivalent outcomes for telehealth therapy as compared to face-to-face therapy.

    Telehealth can be preferable to in-person therapy due to no travel time, and being in the comfort of your own home.

  • The length of treatment is always determined between the client and the therapist, but if you are using insurance it is important to check with your insurance company and inquire about any caps on number of sessions billable within a year.

    While duration of treatment can vary, I typically work with clients for between 3 months and 2 years.