Using out-of-network benefits
If your plan is not one we are in-network with, you may still get much of the cost back. Here is how it works, step by step.
Crown Counseling is in-network with most major plans, and that is the simplest route. If we are out of network for your plan, PPO and POS plans usually include out-of-network benefits that reimburse a share of each session. HMO and EPO plans generally do not. Not sure which you have? Send us your card and we will check.
How it works
- 1
Check your benefits
Call the number on your insurance card and ask the questions below, or send us your plan details and we will check for you.
- 2
Pay at the time of service
You pay the full session fee to us. Most PPO and POS plans reimburse a share of it once your out-of-network deductible is met.
- 3
Get your superbill
After each session, or monthly if you prefer, we give you a superbill: a detailed receipt with everything your insurer needs.
- 4
Submit and get reimbursed
Send the superbill to your insurer, online or by mail. They pay you back directly at your plan’s out-of-network rate.
Know the terms
Four words that decide your reimbursement
- Deductible
- What you pay for care each year before your plan starts paying its share. Out-of-network deductibles are usually separate from, and higher than, in-network ones.
- Coinsurance
- Your percentage of the cost after the deductible is met. If your plan covers 70%, your coinsurance is 30%.
- Allowed amount
- The fee your insurer considers reasonable for a session. Reimbursement is a percentage of this figure, not always of what you paid.
- Out-of-pocket maximum
- The most you pay in a plan year. After you reach it, covered services are paid in full.
Call your insurer
What to ask
The number is on the back of your card. Write the answers down; you will want them when you submit claims.
- Do I have out-of-network benefits for outpatient mental health?
- What is my out-of-network deductible, and how much of it have I met this year?
- What is my coinsurance for out-of-network mental health sessions?
- What is the allowed amount for CPT codes 90791, 90834, and 90837?
- Is there a limit on sessions per year, or a pre-authorization requirement?
- Are telehealth sessions covered at the same rate as in-person?
- How do I submit a claim, and what is the deadline after the date of service?
Would rather we do the calling?
Fill out the form at the bottom of this page with your plan details. We check your out-of-network benefits and get back to you — usually the same day.
The codes on your superbill
Insurers price sessions by CPT code. These are the ones we use. Telehealth sessions use the same codes with a telehealth modifier (95).
| Code | Service | Note |
|---|---|---|
| 90791 | Initial intake evaluation | First appointment, usually 60 minutes |
| 90834 | Individual therapy, 45 minutes | The standard session |
| 90837 | Individual therapy, 60 minutes | Extended session |
| 90847 | Family or couples therapy | With the client present |
| 90846 | Family therapy | Without the client present |
What a superbill includes
A superbill is a receipt with the details an insurer needs to process a claim. Ours include:
- Our practice name, address, NPI, and tax ID
- Your name, address, and date of birth
- The date and length of each session
- The CPT code for each session and your ICD-10 diagnosis code
- The fee charged and the amount you paid
Tips for claims
- Submit after each session or once a month. Most plans have a filing deadline, often 90 days to a year.
- Ask for reimbursement checks to be made out to you, not to Crown Counseling. We return checks made out to the practice.
- Keep copies of every claim and reply. If you hear nothing within 30 days, follow up.
- A denial is not always final. Ask why, then appeal with the superbill and your benefit details.
- Benefits change yearly. Re-check yours each January and whenever your plan changes.
Check your out-of-network benefits
Fill out the short form below with your plan details. We check your out-of-network benefits for you and get back to you — usually the same day.
Prefer to talk? Call (718) 208-4780 and a real person answers.
This form is not for emergencies. If you are in crisis, call or text 988, the Suicide & Crisis Lifeline, or dial 911.