Navigating Out-of-Network Benefits
Raíces Holistic Therapy & Psychiatry is out-of-network with all insurance plans. Full fees are due directly to the practice at the time of each appointment. However, if your plan includes out-of-network benefits, you may be eligible for partial reimbursement — and I want to help make that as accessible as possible.
I partner with Thrizer to simplify this process. After each appointment, your superbill is submitted automatically through Thrizer, so you don't have to file anything yourself or wait on paperwork.
Check Your Benefits
Before your first appointment, you can check your estimated out-of-network benefits here: Check Your Benefits
If you have a PPO plan, your insurance may reimburse you 60–80% of appointment fees after your out-of-network deductible is met.
If you'd like more detail than the benefits check provides, you can also call the member services number on the back of your insurance card and ask:
"What is my out-of-network deductible, has it been met, and when does it renew?"
"What percentage will my plan cover for out-of-network mental health care after I meet that deductible?"
"Does my plan have maximum allowable amounts or usual and customary rates?"
"If so, what are the allowable amounts for the following CPT codes: 99204, 99212, 99213, 99214, 90833, 90836, 90837?"
"What is my out-of-network annual out-of-pocket maximum?"
"Is prior authorization required? If so, what is the process?"
"Are my benefits on a calendar year or plan year basis? If plan year, when does it start?
Important Notes
Full fees are always due at the time of service, regardless of reimbursement status.
While I provide superbills and support your reimbursement process, you are responsible for understanding your own out-of-network coverage and any personal financial responsibility.
Insurance decisions are made by your plan and are outside of my control.
Questions? Reach out through the patient portal or book a free 20-minute consultation to talk through fit and finances before committing to anything.