You don't necessarily have to choose between using your insurance and seeing a therapist who isn't in your insurance network.

Whitecap Counseling is primarily a private-pay, out-of-network practice. If your health insurance plan includes out-of-network mental health benefits, your insurance company may reimburse you for a portion of your therapy cost.

How does it work?

1. You pay Whitecap Counseling $120 for your session.

2. My administrative assistant can verify your insurance benefits directly with your insurance company to determine whether your plan includes out-of-network mental health coverage and gather information about your potential reimbursement.

3. I provide you with a superbill. A superbill is a document containing the information your insurance company needs to process your claim.

4. You submit the superbill to your insurance company.

5. Your insurance company processes the claim according to the specific terms of your plan and reimburses you directly, if applicable.

How much might I get back?

That depends on your individual insurance plan.

Your reimbursement may depend on how much you must pay before your insurance begins reimbursing you, what percentage your plan pays after that point, and the amount your insurance company considers the cost of the service.

Because every plan is different, insurance verification can give you a better idea of what to expect, but it cannot guarantee a specific reimbursement amount. Your insurance company makes the final determination when the claim is processed.

Prefer not to use insurance?

That's completely fine. You can use Whitecap Counseling as a private-pay practice without submitting claims to insurance.

Important: Out-of-network reimbursement is determined by your insurance company. Whitecap Counseling does not determine your coverage, reimbursement amount, deductible, or other insurance benefits.

That depends on your individual insurance plan.

Your reimbursement may depend on how much you must pay before your insurance begins reimbursing you, what percentage your plan pays after that point, and the amount your insurance company considers the cost of the service.

For example: If you pay $120 for a therapy session and your insurance company determines that its allowed amount for that service is $100, a plan that reimburses 70% of the allowed amount could reimburse you $70. Your effective cost would then be $50.

This is only an example. Your actual reimbursement may be different based on your specific plan.

My administrative assistant can verify your insurance benefits directly with your insurance company to help you understand whether you have out-of-network coverage and what your plan may reimburse. Verification of benefits does not guarantee payment. Your insurance company makes the final determination when your claim is processed.

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can typically use those funds to pay for eligible therapy expenses, including amounts you pay toward your deductible. Eligibility and reimbursement rules can vary, so check with your plan administrator or account provider to confirm your specific benefits.

You have two options for finding out whether your insurance may reimburse you for out-of-network therapy.

Option 1: Check with your insurance company

Call the member services number on the back of your insurance card and ask:

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

• What is my out-of-network deductible, and how much have I met?

• What percentage of the allowed amount does my plan reimburse after my deductible?

• What is the allowed amount for CPT code 90837?

• Do my out-of-network benefits cover telehealth services?

Option 2: Have us verify your benefits

My administrative assistant can contact your insurance company directly to verify your benefits and gather information about your out-of-network coverage and potential reimbursement.

Insurance verification is provided as a courtesy and does not guarantee that your claim will be paid or that your insurance company will reimburse a specific amount. Your insurance company makes the final determination when the claim is processed.