Navigating Finances for Mental Health Care in NY, NJ, & CT
Out-of-Network: Insurance Options for Therapy
Metro NY DBT Center is an out-of-network provider.
This means that we do not have a direct contract with any insurance companies.
What this means for you:
As a client, you are responsible for paying for your services directly to us at the time of your appointment. We will then provide you with a detailed receipt (often called a "superbill") that contains all the necessary information for you to submit a claim to your insurance company. If you have out-of-network benefits, your insurance plan may reimburse you for a portion of the cost. We recommend contacting your insurance provider directly to understand the specifics of your out-of-network coverage for mental health services.
Paying for Therapy: Your Insurance Questions Answered
At Metro NY DBT Center, we understand that navigating health insurance coverage for mental health care can be a confusing and frustrating process. We are committed to helping you understand your rights and the resources available to you. This page provides information to help you file claims and secure the coverage you are entitled to under your policy and the law.
Our goal is to empower you with the knowledge to make informed decisions about your care.
Understanding Your Right to Coverage
Under the law, insurers must treat mental health care in the same way they treat physical health care. In 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) was passed, which requires most health plans to cover treatment for mental health and substance use disorders no more restrictively than treatment for physical illnesses like diabetes or heart disease.
Despite these legal protections, claim denials are common. Knowing your rights is the first step in successfully advocating for your care.
How to Work Through Challenges with Insurance Claims
Even with parity laws in place, insurers may deny claims for mental health care for a variety of reasons. Being aware of these common reasons can help you prepare your claim and any potential appeals.
It's important not to be discouraged by an insurer's initial denial or their published treatment criteria, as these may not align with generally accepted standards of care or may violate parity laws.
How to Appeal a Denied Mental Health Claim
If your claim is denied, you have the right to appeal the decision. This process can be complex and varies by insurer.
Key Steps & Recommendations:
Request a "Medical Necessity Letter": Your clinician can provide this letter to document why your treatment is essential. It's a helpful tool for appeals.
Seek Expert Guidance: Before starting an appeal, we strongly recommend seeking advice from insurance claims experts or patient advocacy groups.
Be Careful with Inquiries: When speaking to an insurer, clearly state that your questions are NOT an official appeal. Insurers may limit the number of appeals and have been known to count simple inquiries toward that limit.
Patient Resources for Insurance & Mental Health
You are not alone in this process. Several organizations provide excellent resources for patients dealing with insurance claims for mental health care.
- The Kennedy Forum (www.thekennedyforum.org) and its ParityTrack initiative offer information on your rights and state-specific laws.
- Don't Deny Me (www.dontdenyme.org) is a resource from the Kennedy Forum with tools to help you fight a denial.
- The Austen Riggs Center (www.austenriggs.org) provides helpful blog posts and guides on navigating insurance coverage.
Insurance, Fees & Reimbursement: Frequently Asked Questions
Is Metro NY DBT Center in-network with any insurance plans?
No, Metro NY DBT Center is an out-of-network provider. This means we do not have direct contracts with any insurance companies. Clients pay for services directly at the time of their appointment.
How can I get reimbursed for therapy if you are out-of-network?
After each session, we will provide you with a detailed receipt, often called a "superbill." You can submit this document directly to your insurance company. If your plan includes out-of-network benefits for mental health, your insurer will reimburse you for a portion of the cost.
How do I find out about my out-of-network benefits?
The best way is to call the member services number on the back of your insurance card. Ask them specifically about your "out-of-network outpatient mental health benefits." Key questions to ask include what your deductible is, what percentage of the fee they cover, and if you need pre-authorization.
What is the Mental Health Parity Act?
The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that requires most insurance plans to cover mental health and substance use disorder treatments no more restrictively than they cover medical and surgical care. This law is a key tool in advocating for your right to coverage.
What should I do if my insurance company denies my claim?
First, don't be discouraged, as denials can be appealed. We recommend requesting a "Medical Necessity Letter" from your clinician and seeking guidance from patient advocacy groups like The Kennedy Forum. When speaking to your insurer, always clarify that your inquiries are not an official appeal to avoid using up your limited appeal chances.
What is a superbill for therapy?
A superbill is a detailed, itemized receipt we provide for your therapy sessions. As an out-of-network provider, we give you this document which includes all the necessary service and diagnosis codes. You can then submit this superbill directly to your insurance company to request reimbursement for your payments, according to your plan’s specific out-of-network benefits.
How long does insurance reimbursement take?
Reimbursement timeframes vary widely by insurance company and plan. After submitting your superbill, some insurers may process a claim in 2-4 weeks, while others can take 60 days or more. For the most accurate timeline, we recommend checking your insurer's online portal or contacting them directly after you have submitted your first claim for an estimate.
What should I ask my insurer about mental health benefits?
When you call your insurer, ask specifically about your "out-of-network, outpatient mental health benefits." Key questions to ask are:
- What is my annual deductible, and have I met any of it?
- What percentage of the fee do you reimburse after the deductible is met?
- Is any pre-authorization required before I can start therapy?
- How do I submit my superbill for reimbursement?