If you've started looking for a specialized trauma or sex therapist in the DC area, you've probably noticed that many don't take insurance. That includes our practice. It can feel like a barrier at first, especially if you're used to handing over a card and paying a copay. But out-of-network therapy is often more affordable than people expect, and for many women it's the better choice for reasons that have little to do with money.
Here's how it works.
What "out-of-network" means
An in-network therapist has a contract with your insurance company. She accepts its rates and its rules, and you pay a copay. An out-of-network therapist has no contract. You pay her directly, then ask your insurer to reimburse part of the cost through your plan's out-of-network benefits.
Many PPO plans, and some POS plans, include out-of-network mental health benefits. HMO and EPO plans usually don't, except in limited circumstances.
How reimbursement works
You pay for each session.
Each month, we give you a superbill: a detailed receipt with everything your insurer needs, including session dates, the service code, our license information, and a diagnosis code.
You submit the superbill to your insurance company, usually through its website or app.
Once you've met your out-of-network deductible, your insurer reimburses a percentage of what it considers the "allowed amount"*for that service.
* Your insurer reimburses a share of what it decides the session is worth, which may be less than what you paid. If your plan pays 70% of an allowed amount that's lower than our fee, you'll get back less than 70% of your payment.
Questions to ask your insurance company
Call the member services number on your card and ask:
Do I have out-of-network outpatient mental health benefits?
What is my out-of-network deductible, and how much have I met this year?
What percentage do you reimburse after the deductible?
What is the allowed amount for CPT code 90834 (a 45-minute session) and 90837 (a 55-minute session)?
Is there an out-of-pocket maximum for out-of-network care?
Do I need pre-authorization?
How do I submit a claim, and how long does reimbursement usually take?
Write down the representative's name and the date of the call. Answers can vary from one call to the next.
What it might cost you
Our current rates are $195 for a 45-minute session and $238 for a 55-minute session with our associate therapists, and $245 and $295 with Dr. Joanne Bagshaw.
Here's a hypothetical example. Say you've met your deductible, your plan reimburses 60%, and its allowed amount for a 55-minute session is $180. You'd get back about $108, so a $238 session would cost you about $130. Your plan's numbers will be different, which is why the call above is worth making.
You can often use HSA or FSA funds for therapy as well. Check your plan's rules.
Why many women and choose out-of-network care anyway
Specialization. Many therapists with advanced training in trauma, sex therapy, and couples work don't join insurance panels. Going out-of-network opens your options to the people who specialize in what you need.
Treatment decisions stay between you and your therapist. In-network care can come with limits on session length, frequency, or number of sessions, and sometimes requires reviews to justify continued treatment. Out-of-network, you and your therapist decide what makes sense.
More control over your information. Every insurance claim includes a diagnosis code. If you submit superbills, that code goes to your insurer. If privacy matters a lot to you, as it does for many women in visible or sensitive roles, you can pay privately and not submit claims at all. Then your therapy doesn't appear in your insurance records.
Is it worth it?
That depends on your plan, your budget, and what you're hoping to change. But many of the women we work with have spent years doing everything right on paper while feeling disconnected underneath. When you weigh the cost of therapy against the cost of staying stuck in burnout, a strained relationship, or a body that never fully relaxes, focused work with a specialist is often the more efficient path.
Good to know: your right to a Good Faith Estimate
Under the federal No Surprises Act, if you're not using insurance to pay for care, you have the right to a Good Faith Estimate of what it will cost. You can read ours on our Good Faith Estimate page.
Next steps
Check your out-of-network benefits, then visit our Rates & Payments page or schedule a free consultation. We're glad to answer questions about fees and superbills before you begin.
