Fees & Insurance

For individual therapy, the first session is a 60-minute intake ($220), and ongoing individual sessions are $185 for 50 minutes. For couples, the first session is a 75-minute intake ($275), and ongoing couples sessions are $220 for 60 minutes. I'm an out-of-network provider, so I don't bill insurance directly. You pay for each session, and on request I provide a superbill: a detailed receipt you can send to your insurance company. If your plan has out-of-network mental health benefits, usually a PPO, your insurer may pay part of the cost back to you once you've met your deductible.

I'm Anat Mor Betzalel, a Licensed Clinical Social Worker (California LCSW #97610) in Rancho Peñasquitos, San Diego. People often ask in their free consultation how paying out of network works with their insurance, so here is the plain-English version, including the questions worth asking your insurer before your first session.

Free 15-Min Consultation

Fees

  • Free 15-minute consultation: no charge
  • Individual intake (first session), 60 minutes: $220
  • Individual therapy, ongoing sessions, 50 minutes: $185
  • Couples intake (first session), 75 minutes: $275
  • Couples therapy, ongoing sessions, 60 minutes: $220
  • Walk and talk therapy, 50 minutes: $185

I accept cash, check, credit cards (Visa, Mastercard), Venmo, Zelle and PayPal. HSA/FSA cards may be used when eligible and accepted by your card issuer. Please give at least 24 hours' notice to cancel or reschedule. Sessions cancelled with less notice are charged the full session fee.

What does "out-of-network" mean for therapy?

It means the therapist has no contract with your insurance company. With an in-network therapist, you usually pay a copay and the therapist bills your insurer. With an out-of-network therapist, you pay the full fee and claim back whatever your plan allows.

Many therapists stay out of network so that session length, frequency and approach are decided between client and therapist, not by an insurer's rules. The trade-off is that you pay up front and handle the claim yourself.

What is a superbill?

A superbill is a detailed receipt with the information your insurance company needs to process a claim: the dates of your sessions, the amount you paid, my license information, a procedure code for the type of session, and a diagnosis code. I provide superbills on request.

That last item is worth knowing about. Insurers generally reimburse only for treatment of a health condition, so a superbill carries a diagnosis code. If you'd rather your insurer not receive one, you can always pay privately and not submit. We can talk it through in your consultation.

How do I get reimbursed?

  1. 1Pay for your session.
  2. 2Ask me for a superbill.
  3. 3Submit it through your insurer's member website or app, or with their paper claim form.
  4. 4Your insurer sends any reimbursement to you by check or direct deposit.

Most plans have a deadline for submitting claims, so ask yours and submit regularly instead of saving superbills up. Some clients use third-party services such as Thrizer to help submit superbills or manage reimbursement. That's entirely your choice; it isn't a service I provide.

What should I ask my insurance company before I start?

Call the member services number on your insurance card and ask:

  • 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 this year?
  • Once I meet it, what percentage do you reimburse?
  • What is your allowed amount for procedure code 90791 (the first session, or intake), 90834 (a 50-minute individual session) and 90847 (couples sessions)?
  • Do I need pre-authorization? Is there a limit on sessions per year?
  • Are telehealth sessions covered out of network?
  • How do I submit a claim, and how long does reimbursement take?

Write down the date, the name of the person you spoke with and the call reference number.

How much will I get back?

It depends on your plan, and the detail most people miss is the "allowed amount." Insurers usually reimburse a percentage of what they decide a session is worth, not a percentage of the fee you paid.

Here's an example to show the math. Say your plan reimburses 60% of an allowed amount of $120, and you've met your deductible. For a $185 session you'd get $72 back, so the session costs you $113. Your plan's numbers will be different.

Until you meet your out-of-network deductible, you usually get nothing back. Submit your superbills anyway, because they count toward the deductible.

Can I use my HSA or FSA for therapy?

Usually, yes. IRS Publication 502 counts "therapy received as medical treatment" as a qualifying medical expense. HSA/FSA cards may be used when eligible and accepted by your card issuer. Couples sessions can be less clear-cut, so check with your plan administrator before using your HSA or FSA for those.

What if I have an HMO or no out-of-network benefits?

HMO and EPO plans usually don't cover out-of-network care except in emergencies. You can still pay privately with any of the payment methods above.

If you are uninsured or choosing not to use insurance for your care, you have the right to receive a Good Faith Estimate of your expected costs. Read more about your rights below.

Your right to a Good Faith Estimate

If you are uninsured or choosing not to use insurance for your care, you have the right to receive a Good Faith Estimate of your expected costs. This right comes from a federal law called the No Surprises Act.

  • You can ask me for a Good Faith Estimate of the total expected cost of your sessions.
  • You should receive it in writing at least 1 business day before your first session. You can also ask for one before you schedule, and you'll get it within 3 business days.
  • If your bill comes in at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Keep a copy or a photo of your Good Faith Estimate.

For more about your rights, read the official notice from the Centers for Medicare & Medicaid Services (CMS) (PDF), visit www.cms.gov/nosurprises/consumers, or call 1-800-985-3059.

Common questions

Do you take insurance?

No. I'm an out-of-network provider. On request, I provide a superbill that you can submit to your insurance company for possible reimbursement if your plan has out-of-network benefits.

Is a superbill the same as a receipt?

It's a receipt with extra detail: the procedure and diagnosis codes, my license information and the dates of service. That's the information an insurer needs to process an out-of-network claim.

Will insurance reimburse couples therapy?

Sometimes. Some plans cover couples sessions only in certain situations, so ask your insurer specifically about couples sessions (code 90791 for the first session and 90847 after that) before you start.

Can I use my HSA to pay for therapy?

Usually, yes, for therapy received as medical treatment. If you're unsure whether your sessions qualify, check with your plan administrator.

Have a question about cost or whether we're a good fit? Book a free 15-minute consultation or call (858) 215-2234.

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