Insurance & Payment
Insurance & Payment
Clear information up front, so cost isn't a guessing game.
What we accept in Maryland
For therapy at our Maryland practice, we are in network with CareFirst BCBS. For all other insurance, we are out of network. We provide superbills so you can submit claims to your insurance for out-of-network reimbursement. We do not accept Medicare or Medicaid.
Accessing mental health care matters, and we know that figuring out coverage can be the part that stops people from reaching out at all. To make care more accessible, we offer:
- Superbills for out-of-network services, so you can submit claims to your insurance company for reimbursement
- Initial discounts for self-pay clients
- EMDR Intensives as a way to reduce the long-term financial burden by compressing focused trauma work into a few concentrated days
- Additional resources for those struggling to pay; please reach out via email and our intake team can help
On occasion we receive grant funding for services. Sign up for our newsletter or reach out to intake to hear about new insurance plans we may accept or grant funding as it becomes available.
Out-of-Network benefits for mental health therapy
Many clients assume that seeing an in-network therapist is the only affordable option. That is not always the case. If your therapist is considered out-of-network, you may still be eligible for partial reimbursement through your insurance plan.
Why consider out-of-network therapy
- Access to specialized care. Out-of-network therapists may offer expertise (such as trauma-informed or evidence-based care) that is not always available in-network.
- Freedom of choice. Choose a therapist who truly fits your needs rather than being limited by an insurance directory.
- Increased privacy. Out-of-network providers often limit the amount of clinical information shared with insurers.
How to seek reimbursement from your insurance
1. Verify your benefits.
Call the number on the back of your insurance card and ask:
- "Do I have out-of-network benefits for mental health therapy?"
- "What is my deductible, and how much has been met?"
- "What is the reimbursement rate for CPT codes 90791 and 90837?"
- "Is pre-authorization required?"
- "How do I submit a claim for reimbursement?"
Note: if going out-of-network, you will be responsible for billing your insurance company.
2. Ask about a "Gap in Coverage Exception."
If you are having difficulty finding an in-network provider with availability or the right specialty, ask:
- "Can I request a Gap in Coverage Exception to see an out-of-network therapist at in-network rates?"
If approved, this temporarily allows you to be reimbursed at higher rates for out-of-network care due to the lack of adequate providers in-network.
Note: we do not take single case agreements.
3. Pull a superbill from the electronic medical record.
A superbill is a detailed receipt with the information your insurance needs to process the claim: diagnosis code, session type, dates, and fees. Ask our intake team how to access your superbills through the electronic medical record.
4. Submit the claim.
Log in to your insurance portal or mail a claim form along with your superbill.
5. Receive reimbursement.
Your insurance provider will send you a reimbursement check based on your plan's out-of-network rate.
Tips for success
- Keep detailed records of your submissions and communications with your insurance.
- Appeal denied claims; you may still be approved on a second pass.
- Use tools like Reimbursify or Mentaya to simplify the submission process.
Out-of-network therapy can be more accessible than you think, and your mental health is worth the investment.
Third-party payers we work with in Maryland
In addition to insurance, we work with the following third-party payers in Maryland:
- CAC (Child Advocacy Center) referrals
- Change the Conversation
- DSS (Department of Social Services) referrals
These arrangements are subject to change. Please talk with our intake specialists to confirm or gain clarification before scheduling.
Couples and insurance
Couples and family therapy comes with specific insurance considerations that are different from individual therapy.
How insurance billing works for couples
Insurance companies typically only allow one person to be listed as the client for billing purposes. This means the therapy must focus on treating a diagnosed mental health condition for that one individual, and all notes and documentation must reflect that. Because this is a tricky requirement to meet, and because not all insurance plans cover couples or family therapy, many clients choose to pay out of pocket instead.
If your therapist determines that the criteria for insurance billing are not met, sessions will be classified as self-pay and will not be eligible for insurance reimbursement. Our therapists are specifically trained in medical-necessity criteria for couples and family sessions.
Check with your insurance provider
We strongly recommend calling your insurance company to ask whether they cover couples or family therapy, and under what circumstances. Every plan is different, and knowing ahead of time can help avoid unexpected costs. We're happy to talk through your options and answer any questions you may have.
Forms of payment
We accept credit cards, debit cards, and HSA/FSA cards for self-pay sessions, copays, and coinsurance. Therapy sessions are typically eligible for HSA/FSA reimbursement.
For CareFirst BCBS clients, we bill your insurance directly. You'll be responsible for any copay, coinsurance, or amount applied to your deductible at the time of the session.
Your right to a Good Faith Estimate
Under the federal No Surprises Act, you have the right to receive a Good Faith Estimate of expected charges if you are uninsured or paying for therapy yourself rather than through insurance. The estimate covers what you can expect to pay over the course of treatment based on what we know at the start.
We provide a Good Faith Estimate on request and as part of standard intake for self-pay clients. If your actual charges differ significantly from the estimate, you have the right to dispute the difference. For more information, visit cms.gov/nosurprises.
Frequently Asked Questions
What insurance do you accept in Maryland?
For therapy at our Maryland practice, we are in network with CareFirst BCBS. For all other insurance, we are out of network. We provide superbills so clients can submit claims for out-of-network reimbursement. We do not accept Medicare or Medicaid.
What if my insurance is not CareFirst BCBS?
You can still work with us on a self-pay basis. Many plans reimburse for out-of-network mental health benefits. We provide superbills with all the codes your insurance needs to process the claim. Out-of-network coverage often includes access to specialized care like ours, freedom of choice in selecting your therapist, and more privacy in what gets shared with insurers.
How do I find out what my out-of-network benefits cover?
Call the number on the back of your insurance card and ask: Do I have out-of-network benefits for mental health therapy? What is my deductible, and how much has been met? What is the reimbursement rate for CPT codes 90791 and 90837? Is pre-authorization required? How do I submit a claim for reimbursement?
What is a Gap in Coverage Exception?
If you are having difficulty finding an in-network provider with availability or the right specialty, you can ask your insurance company about a Gap in Coverage Exception. If approved, this temporarily allows you to be reimbursed at higher rates for out-of-network care due to the lack of adequate providers in-network. Please note: we do not take single case agreements.
Do you take Medicare or Medicaid?
No. We are not enrolled with Medicare or Medicaid and cannot bill these programs.
What is a superbill?
A superbill is a detailed receipt with all the information your insurance needs to process an out-of-network reimbursement claim: diagnosis code, session type, dates, and fees. We provide superbills through our electronic medical record on request. You then submit the superbill to your insurance, either through your member portal or by mail, and your insurance reimburses you directly based on your plan's out-of-network rate.
Do you offer self-pay options?
Yes. We offer self-pay rates for clients who do not want to use insurance, do not have insurance, or whose insurance does not cover therapy. Initial discounts are available for self-pay clients. We also offer EMDR Intensives as a way to reduce the long-term financial burden by compressing focused trauma work into a few concentrated days. If cost is a barrier to care, please reach out and we can talk through options.
Are couples or family sessions covered by insurance?
Sometimes, but with specific limits. Insurance companies typically only allow one person to be listed as the client for billing, which means therapy must focus on treating that individual's diagnosed mental health condition, with all documentation reflecting that focus. Not all insurance plans cover couples or family therapy. If your therapist determines that the criteria for insurance billing are not met, sessions will need to be classified as self-pay. We strongly recommend calling your insurance to ask whether they cover couples or family therapy and under what circumstances.
Are EMDR intensives covered by insurance?
EMDR intensives are not covered by insurance and are paid out of pocket. The intake session before an intensive can typically be billed through CareFirst BCBS if you have it. Prepayment is required in advance of scheduling the intensive.
What is a Good Faith Estimate?
Under federal law (the No Surprises Act), if you are uninsured or paying for therapy yourself rather than through insurance, you have the right to a Good Faith Estimate of expected charges before starting care. We provide this on request and as part of standard intake for self-pay clients. More information at cms.gov/nosurprises.
Questions about cost or insurance?
Our intake team can help you figure out what your benefits cover, what the self-pay rate looks like, and what additional resources might fit. The conversation is free.
If a form doesn't feel right, you can also email us at info@traumaspecialistsofmd.com.