INSURANCE FAQs

DO YOU ACCEPT HEALTH INSURANCE?

No. Unfortunately, the health insurance system is quite unfriendly to mental health providers. Between extremely low payments, high administrative/paperwork load, and insurers being allowed to dictate treatment length and type, we find that we are not comfortable participating in this system. We are considered Out of Network providers.

WHAT ARE "OUT OF NETWORK" BENEFITS?

Out of Network (OON) providers are any healthcare providers who have not entered into a contract with your insurance plan. All Sunlight Psych providers are considered OON because we do not participate in insurance networks. Depending on your insurance plan, you may be eligible to receive full or partial reimbursement for healthcare fees paid to OON providers (like us). When using OON benefits, you pay treatment fees directly to the provider at the time of service, and then pursue reimbursement from your insurance carrier. To learn more about your potential OON benefits, we recommend that you call your insurance carrier and ask them these questions:

What is my Out of Network coverage?
Do I need to meet a deductible before using Out of Network coverage, or can I start now?
If I were to pay $250 for a therapy session, how much would you reimburse? (See below for a list of typical CPT codes)

WHAT IS A "SUPER BILL"?

A super bill is a detailed receipt for medical services that were paid out of pocket. It includes the date of services, procedure codes to clarify which exact services you received, amount paid, and any diagnosis that you have been diagnosed with by the provider. We provide monthly super bills to any client who requests them.

WHICH CPT CODES SHOULD I ASK ABOUT?

A CPT code, also called a Procedure Code, tells insurance companies exactly what service(s) you received from a healthcare provider. When talking to your insurance company about OON services, they sometimes request advance notice about which precise services you will be receiving. Here are the CPT codes we typically utilize at Sunlight Psych for THERAPY:

90791: Individual Diagnostic Evaluation (Intake)
90834: Individual Psychotherapy (38-52 minutes)
90846: Family Psychotherapy Without Patient Present
90847: Family Psychotherapy With Patient Present

Here are the CPT codes we utilize for TESTING:

90791: Individual Diagnostic Evaluation (Intake)
90846: Family Psychotherapy Without Patient Present (Sometimes used for feedback session)
90847: Family Psychotherapy With Patient Present (Sometimes used for feedback session)
96130: Psychological testing/evaluation by a psychologist (first hour)
- +96131: Add-on code, Psychological Testing/Evaluation by a Psychologist (each additional hour)
96136: Psychological or Neuropsychological Test Administration/Scoring by Psychologist (First 30 min)
- 96137: Add-on code, Psychological or Neuropsychological Test Administration/Scoring by Psychologist (Each additional 30 min)

DO YOU ACCEPT ANY EMPLOYER ASSISTANCE PROGRAMS (EAP)?

All of our psychologists are paneled with Lyra Health. Lyra is an EAP that covers many major tech and biochemical companies, as well as large chains such as McDonalds and Starbucks. Ask your HR department whether your company is contracted with Lyra Health. Be sure to specify you are a Lyra patient when you reach out so we can guide you through using your Lyra benefits.

DO YOU HAVE ANY RESOURCES TO HELP ME NAVIGATE THIS?

Yes! We recommend this article for a more detailed explanation of WHY so few mental health providers work with insurance, and how to explore your OON options: https://mywellbeing.com/therapy-101/insurance

We also recommend the Reimbursify app which helps streamline your experience of submitting super bills for reimbursement: https://reimbursify.com/individual-page/