Insurance reimbursement
Out-of-Network Reimbursement
Understand the cost, possible reimbursement, and questions to ask your insurance plan before scheduling.
Sattva Psychiatry is cash-pay and out-of-network. Payment is due at the time of service. After each appointment, a detailed superbill is available for patients who wish to submit a claim for possible out-of-network reimbursement.
Reimbursement is determined by your insurance plan and is not guaranteed. The most accurate estimate comes directly from your insurer. FAIR Health may be useful as a general reference for typical out-of-network charges in your area.
Before submitting claims
Check your plan directly.
Out-of-network reimbursement depends on your individual insurance plan, deductible status, out-of-network benefits, allowed amounts, telehealth coverage, and insurer policies.
A superbill can support a patient-submitted claim, but it does not guarantee payment from your insurance plan.
Some plans, including many HMOs, Medicaid, Medicare, TRICARE, and certain marketplace plans, may not reimburse out-of-network care. If reimbursement is important to you, check directly with your insurance plan before scheduling.
Fees and code examples
Information your insurer may request.
Insurance plans often ask about fees and CPT codes when estimating out-of-network reimbursement.
The following are general examples. The code used for a specific visit depends on the service provided, clinical documentation, medical decision-making, and applicable coding rules.
These examples are provided to help you ask informed questions. They do not guarantee that your insurer will cover or reimburse any specific service.
Superbills and claims
How Out-of-Network Reimbursement Works
Payment is made to the practice at the time of service. Reimbursement, if available, is handled between the patient and insurer.
Sattva Psychiatry is a cash-pay, out-of-network practice and does not bill insurance directly. Payment is due at the time of service.
A detailed superbill is available after each appointment for patients seeking possible out-of-network reimbursement. A superbill is an itemized document that may include provider information, diagnosis codes, service codes, dates of service, and fees paid.
Patients are responsible for submitting superbills to their insurance plan and communicating with their insurer about reimbursement, claim status, denials, appeals, or requests for additional information.
Providing a superbill does not guarantee reimbursement.
Deductibles, allowed amounts, and coverage rules
Why Reimbursement Varies
Two patients with different plans may receive very different reimbursement for the same service.
Out-of-network reimbursement varies widely across insurance plans. It may depend on:
- whether your plan includes out-of-network mental health benefits
- whether telehealth psychiatric visits are covered
- whether you have met your out-of-network deductible
- your out-of-network coinsurance rate
- your insurer’s allowed amount for the service
- whether prior authorization or other plan requirements apply
- how your insurer processes psychiatric evaluation and follow-up codes
Your insurer may reimburse based on its allowed amount rather than the amount you paid.
Benefit verification
Questions to Ask Your Insurance Plan
Your insurer is the source of truth for benefit details and claim submission rules.
You may call the number on the back of your insurance card or use your member portal. You can say:
“I am considering seeing an out-of-network psychiatrist via telehealth. Can you help me estimate my reimbursement for outpatient psychiatric evaluation and medication management?”
You may wish to ask:
- Do I have out-of-network benefits for outpatient psychiatric care?
- Do I have out-of-network benefits for telehealth psychiatric visits?
- What is my out-of-network deductible, and how much has been met?
- What is my coinsurance after the deductible is met?
- Is reimbursement based on billed charges or on the plan’s allowed amount?
- What is the allowed amount for CPT code 90792?
- What is the allowed amount for CPT code 99214 or 99215?
- Do I need prior authorization for out-of-network psychiatric services?
- How do I submit a superbill for out-of-network reimbursement?
External cost reference
Using FAIR Health as a Reference
FAIR Health may be helpful for general context, but it does not determine your plan’s reimbursement.
FAIR Health may be useful as a general reference for typical out-of-network charges in your area. It can help frame expectations, but it does not replace confirmation from your insurance plan.
FAIR Health does not determine your actual reimbursement, deductible, coinsurance, or insurer allowed amount.
Claim submission
Your Role in the Reimbursement Process
The practice provides superbills but does not manage the insurance claim process.
Sattva Psychiatry can provide a detailed superbill after appointments, but does not verify benefits, submit insurance claims, appeal denials, complete insurer forms, or communicate with insurance companies on a patient’s behalf.
Patients are responsible for checking their benefits and deciding whether to submit for possible reimbursement.
This page provides general information only and should not be understood as a guarantee of coverage or reimbursement.
Fees and policies
Review fees and practice policies.
For appointment fees, cancellation policy, clinical scope, and practice boundaries, visit the Fees & Policies page.
Fees & Policies →