Insurance reimbursement
Out-of-Network Reimbursement
Understand the cost, possible insurance payment, 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 payment from their insurance plan.
Insurance payment is determined by your plan and is not guaranteed. The benefits checker and questions below can help you estimate possible out-of-network benefits before scheduling.
Before submitting claims
Check your plan directly.
Out-of-network payment from insurance depends on your individual 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 pay for out-of-network care. If insurance payment is important to your decision, check directly with your insurance plan before scheduling.
Benefits checker
Check possible out-of-network benefits.
This is the most practical first step if you want a benefits estimate before deciding whether to schedule.
Submit a benefits verification request
Reimbursify can help verify whether your insurance plan may include out-of-network benefits for psychiatric care. You may be asked to enter insurance information into Reimbursify’s platform.
The verification is informational. Final coverage decisions, allowed amounts, claim approval, deductible application, denials, and payment amounts are determined by your insurance plan.
Sattva Psychiatry does not bill insurance directly, guarantee insurance payment, verify final claim processing, appeal denials, complete insurer forms, or communicate with insurance companies on a patient’s behalf.
Fees and code examples
Information your insurer may request.
Insurance plans often ask about fees and CPT codes when estimating out-of-network benefits. The examples below are provided to help you ask informed questions.
The code used for a specific visit depends on the service provided, clinical documentation, medical decision-making, and applicable coding rules. These examples do not guarantee that your insurer will cover or pay for any specific service.
Illustrative example
What reimbursement could change.
Some commercial PPO plans reimburse a percentage of out-of-network care after the deductible has been met. Reimbursement can vary widely by plan.
As a high-end illustration only, if a plan reimbursed 80% of the full fee after deductible, the estimated net cost of a $425 initial psychiatric evaluation would be $85. The estimated net cost of a $275 follow-up visit would be $55.
These examples are not a promise of reimbursement. Actual payment may be lower, unavailable, subject to deductible, or calculated from the insurer’s allowed amount rather than the full fee charged by Sattva Psychiatry.
Superbills and claims
How the claim process works.
Sattva Psychiatry does not bill insurance directly. Insurance payment, if available, is handled between the patient and insurer.
Pay at the visit
Payment is made to Sattva Psychiatry at the time of service.
Receive a superbill
A detailed superbill may include provider information, diagnosis codes, service codes, dates of service, and fees paid.
Submit to insurer
Patients submit claims directly to their insurance plan and communicate with the insurer about claim status or requests.
Deductibles and coverage rules
Why insurance payment varies.
Two patients with different plans may receive very different payment for the same service.
Out-of-network insurance payment varies widely across 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 calculate payment based on its allowed amount rather than the amount you paid.
Benefit verification
Questions for 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 benefits for outpatient psychiatric evaluation and follow-up psychiatric treatment?”
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 payment 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 payment?
Claim submission
Your role in the process.
The practice provides superbills. Patients manage their insurance claim process directly with their plan.
Sattva Psychiatry can provide a detailed superbill after appointments, but does not verify final 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 insurance payment.
This page provides general information only and should not be understood as a guarantee of coverage or payment.
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 →