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 provide a monthly superbill through the patient portal after each appointment. This is everything your insurance needs to process a reimbursement claim on your behalf.
Out-of-Network Reimbursement
If you have a PPO plan, your insurance may reimburse you 60–80% of appointment fees after your out-of-network deductible is met.
Before your first appointment, I recommend calling the member services number on the back of your insurance card and asking the following questions:
"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: 90792, 99205, 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.