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.
Reimbursement calculator
What comes back per session
Five numbers from the back of your card. No name, no member ID, nothing stored; the whole calculation runs in your browser.
Back per session, once the deductible is met
$105
Your net cost per session: $95 ($50 of that is the gap between the fee and the allowed amount, which insurance never covers).
- Sessions before the deductible is met
- 20
- After the out-of-pocket max
- $50
- A year of sessions, you pay
- $9,600
- A year of sessions, you get back
- $2,940
$3,000 left. Nothing comes back until then.
Per session, if you reach it.
Net $6,660 for 48 sessions.
An estimate. Insurers finalize each claim after processing, allowed amounts vary by plan and by CPT code, and some plans cap sessions per year. Nothing you type here is stored or sent. Send us your card and we will check your benefits for you.
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.
Crown Counseling is HIPAA compliant. What you share here is protected health information, read only by our intake team.How we protect it
Prefer to talk? Call (718) 208-4780 and a real person answers.
The office is closed, reopening soon. Fill this in and we will come back to you.
This form is not for emergencies. If you are in crisis, call or text 988, the Suicide & Crisis Lifeline, or dial 911.