Private Pay Therapy and Out-of-Network Benefits

It's easy to assume that if a therapist isn't in your insurance network, therapy won't be covered at all. That isn't always true. Depending on your plan, you may have out-of-network benefits that reimburse part of what you pay for sessions.

Brave Embers Wellness is primarily a private-pay practice, and sessions are $175 for 60 minutes. This guide explains the basics in plain language. It isn't financial or insurance advice, and every plan is different, so it's always worth checking your own benefits.

The basics

In-network and out-of-network, explained.

An in-network provider has a contract with your insurance company and bills the insurer directly. An out-of-network provider doesn't have that contract. You pay the provider directly, and then, if your plan includes out-of-network benefits, your insurer may reimburse part of the cost. A few terms come up often:

• Superbill: a detailed receipt listing the service, dates, fees, and the codes insurers use to process a claim.
• Deductible: the amount you pay each year before your plan starts reimbursing. Out-of-network deductibles are often separate from in-network ones.
• Coinsurance: the share of each session your plan reimburses once the deductible is met.
• Allowed amount: what your plan considers a reasonable fee for a service, which can differ from the actual fee.

Working with Thrizer

Help with the paperwork.

I partner with Thrizer, which can submit your superbill and pursue out-of-network reimbursement on your behalf, so you don't have to handle the claim yourself.

If you'd like to know what your plan might cover before you start, you can check your out-of-network benefits in a couple of minutes. Reimbursement always depends on your specific plan, so it's worth checking first. You'll find more details on the rates page.

Why private pay

Care that stays yours.

Private pay isn't only about billing. It also shapes who makes decisions about your care. When you pay privately, no insurer needs a diagnosis before you can be seen, there's no session cap or utilization review deciding whether you still qualify, your records stay between us, and we set the pace and approach together.

If you do use out-of-network benefits, your insurer will generally need a diagnosis and may request records to process claims. Some people decide reimbursement is worth that trade-off, and others prefer to keep everything private. Either choice is valid, and we can talk it through.

Other costs to know

Intensives, groups, and estimates.

Private intensives are $1,500 per day, and most run one to three days. They're self-pay and not covered by insurance. A 50% non-refundable deposit is due 30 days before the scheduled dates, and a superbill can be provided for potential out-of-network reimbursement.

The ten-week groups use equity-based pricing with three self-selected tiers. Under the No Surprises Act, you also have the right to a Good Faith Estimate of expected costs, which is available on request. If you're calling your insurer, these questions can help:

• Do I have out-of-network benefits for outpatient mental health care?
• What is my out-of-network deductible, and how much of it have I met?
• What percentage do you reimburse after the deductible?
• Is there a limit on the number of sessions per year?
• How do I submit a superbill, and how long does reimbursement usually take?

Next steps

Ask anything about fees.

If you have questions about cost, reimbursement, or what makes sense for your situation, you can ask during a free consultation or send a message. You can also read about individual therapy and what sessions include.

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