How to get therapy paid for without insurance
A Guide for Therapy Clients Navigating Insurance
Did you know that in order to use insurance for mental health services, you must receive a formal diagnosis from a licensed provider such as a therapist, counselor, psychologist, psychiatrist, or physician? This requirement exists because insurance companies need to establish that treatment is medically necessary in order to approve and reimburse claims.
However, it’s important to recognize that not everyone who seeks therapy meets the criteria for a clinical diagnosis. Many individuals benefit from therapy simply by having a supportive, nonjudgmental space to explore their thoughts, process experiences, and co-regulate emotionally—regardless of whether their situation constitutes a mental health disorder under diagnostic guidelines.
The complexities of Insurance
Mental health diagnosis can be nuanced and complex. As a trauma and attachment therapist, I often use the CPT (Current Procedural Terminology) code for “Adjustment Disorder” when working with clients navigating life transitions or stressors that don’t meet the threshold for a more severe diagnosis. This code allows us to meet insurance criteria while still honoring the client's lived experience.
That said, an Adjustment Disorder diagnosis is only valid for up to six months. After that, insurance companies typically require a reassessment and, in many cases, a more "serious" diagnosis to continue coverage. This puts clinicians in a difficult position—balancing ethical care and confidentiality with the rigid standards of insurance providers.
Why I Transitioned Away from Insurance
When I first launched my private practice nearly four years ago, I was excited to serve a wide range of clients and got credentialed with several major insurance panels in my state. What I quickly discovered, however, was that each insurance company had its own documentation standards, approved CPT codes, and billing protocols. Navigating this patchwork of requirements was not only time-consuming, it also pulled focus away from what matters most—my clients.
Ultimately, I made the decision to step away from direct insurance billing and adopt a private-pay model. This allows me to center my time, energy, and attention on providing high-quality, personalized care. For clients who still want to use their insurance, I now offer superbills.
What Is a Superbill?
A superbill is a detailed invoice that includes all the necessary information for a client to submit an out-of-network reimbursement claim to their insurance company. It typically includes:
Provider name and credentials
Client’s name and date of birth
Date and duration of sessions
Diagnosis code (ICD-10)
Procedure code (CPT)
Total session fee paid
Provider's NPI (National Provider Identifier) and tax ID
While submitting a superbill doesn't guarantee reimbursement, many clients receive partial refunds—especially if they have a PPO plan with out-of-network benefits. For more information, check out this article from Good RX on superbilling.
The Benefits of Superbills
Offering superbills creates a middle ground between private pay and insurance-based care. As a provider, I’m able to tailor treatment to each client’s unique needs without navigating multiple insurance policies or sacrificing confidentiality. For clients, it offers greater flexibility and the opportunity to reclaim a portion of therapy costs through their insurance.
If you're considering therapy and are unsure whether your insurance covers it, it’s worth calling your insurer and asking:
Do I have out-of-network mental health benefits?
Is pre-authorization required?
What percentage of the fee is reimbursed?
Is there a deductible I must meet first?
These questions can help you make an informed decision about how to pay for care—and whether superbilling might work for you.
Let's Keep the Conversation Going
The world of insurance and mental health care can feel overwhelming, but options like superbills are helping bridge the gap between quality care and affordability. Whether you're a fellow provider or someone exploring therapy, I’d love to hear your thoughts or questions about superbilling.
Feel free to reach out for a free 15-minute consultation:
📞 (303) 847-5224
📧 wildstrengththerapy@gmail.com
📷 @wildstrengththerapy
I look forward to connecting with you.