4 Questions to Ask About Your Out-of-Network Benefits

During November and December, many people go through open enrollment for their medical benefits, including HSAs (Health Savings Accounts) and FSAs (Flexible Spending Accounts). These updates often take effect in January and while new plans can bring exciting options, they can also bring confusion as you try to navigate what’s actually covered.

If you’re exploring therapy or wellness services and wondering how your out-of-network benefits work, you’re not alone. Insurance can be complicated, and at Nourivida Wellness, we want to make this process as simple and transparent as possible. Below are four key questions to ask your insurance company to better understand your coverage for counseling or integrative mental health services.

1. Do I have out-of-network benefits?

Not all insurance plans offer them, so this is the first thing to confirm. Ask your representative whether your specific plan includes coverage for out-of-network mental health or counseling services.

2. What is my out-of-network deductible?

Your deductible determines how much you’ll pay out of pocket before your insurance begins to reimburse you. Knowing this number helps you anticipate your true costs and plan accordingly.

3. Does my plan cover counseling services?

Some policies have separate deductibles or coverage rules for mental health outpatient services. Ask if your plan covers CPT codes 90837 or 90834, which apply to individual counseling sessions. This will tell you whether your therapy sessions are eligible for reimbursement.

4. How do I submit for reimbursement?

Each insurance company handles this differently. Some allow your provider to submit claims directly, while others such as Blue Cross Blue Shield require you to submit a Superbill yourself.

A Superbill is a detailed receipt your therapist provides through your client portal that includes all the information your insurance company needs to process reimbursement. When speaking with your insurance representative, ask about their specific process and submission requirements to avoid delays.

A Note About Coverage at Nourivida Wellness

At Nourivida Wellness, we offer three interconnected paths of care:

• Counseling & Emotional Wellness

• Nutrition Therapy

• Integrative Wellness

Only counseling sessions may qualify for out-of-network reimbursement through your insurance provider. Nutrition therapy and integrative wellness are considered specialized, holistic services, which means they are typically not covered by insurance.

While that may feel limiting at first, choosing out-of-network care allows for greater privacy, flexibility, and personalization free from the restrictions and session limits imposed by insurance models. This approach allows us to prioritize your goals, your values, and your timeline, not the insurance company’s.

You can, however, use your HSA or FSA funds to pay for counseling or nutrition-related sessions, as these are considered qualified health expenses.

Common Questions Clients Ask

Why don’t you take insurance directly?

Working outside the insurance network allows us to provide care that is more flexible, personalized, and integrative. It keeps your information confidential (no diagnostic reporting or treatment reviews) and gives you the freedom to shape your journey without outside interference.

How does reimbursement actually work?

After each session, you’ll receive a Superbill a detailed statement you can upload to your insurance portal or mail in. Most clients are reimbursed by check or direct deposit within 2–4 weeks, depending on their provider.

Can I use my HSA or FSA card?

Yes. Most clients use their HSA/FSA to pay for sessions directly, which is often the easiest way to manage costs tax-free.

At Nourivida Wellness, our goal is to make navigating your benefits as simple and stress-free as possible. We’re always happy to help you understand your options, provide documentation, or guide you through next steps. Your energy belongs in your healing journey not in insurance confusion.

If you have questions about your coverage or want to explore which Nourivida path fits your needs best, we’d be glad to help you find clarity and confidence as you begin.

Yvette is a psychotherapist, Licensed Clinical Social Worker (LCSW), and Certified Mental Health and Nutrition Clinical Specialist (CMNCS) who takes a holistic, faith-informed approach (for those who desire it) to emotional and physical wellness. She integrates neuroscience, psychology, nutrition, and biblical principles to help individuals understand the connection between mind, body, and spirit. Through her work at Nourivida Wellness, Yvette provides concierge counseling and integrative care for those seeking balance, healing, and deeper alignment believing that true transformation happens when emotional health, physical vitality, and spiritual truth come together.