Think of an "in-network" provider as someone who has a contract with your insurance company. They agree to specific rates and rules set by the insurer.

I operate as an "out-of-network" (OON) provider. This means I don't have a direct contract with insurance companies. This approach offers several benefits, including greater privacy for you and more flexibility in our work together, as our treatment plan isn't dictated by your insurance company.

What does this mean for you? It's simple: you pay for your sessions directly, and then you can seek reimbursement from your insurance company. I'll provide you with all the necessary paperwork.

To make therapy more accessible and straightforward for clients who prefer to use their insurance directly, I have partnered with Rula, a mental health platform that manages insurance billing.

How Does It Work?

Think of Rula as the administrative partner that allows you to use your in-network benefits seamlessly. When you book sessions with me through the Rula platform:

1. Rula verifies your insurance to confirm your benefits and eligibility.

2. They tell you exactly what your copay or coinsurance will be before you even book.

3. They handle all the billing directly with your insurance company.

You will only be responsible for your copay/coinsurance at the time of our session, just like a typical visit to a doctor's office. There are no superbills to submit and no waiting for reimbursement.

To see if your insurance is accepted and book through Rula please check out the link below

https://www.rula.com/providers/CA/1740842855-ashley-wilson-dixon

Step 1: Call Your Insurance Company to Verify Your Benefits

This is the most important step! Call the member services number on the back of your insurance card and ask them these specific questions:

• "Do I have out-of-network benefits for mental health (or behavioral health) services?"

• "What is my out-of-network deductible? How much of it have I already met this year?"

• "Once my deductible is met, what is the reimbursement rate (or percentage) for outpatient psychotherapy? (The service CPT code is usually 90837 for individual therapy)."

• "How do I submit my claims? Is there an online portal or a mailing address?"

This call will give you a clear picture of what to expect financially.

Step 2: Pay for Your Session

You will pay my full session fee directly at the time of our appointment.

Step 3: Receive Your "Superbill"

At the end of each month, I will provide you with a detailed receipt called a superbill. This is a standard medical document that contains all the information your insurance company needs to process your claim, including diagnosis and service codes.

Step 4: Submit for Reimbursement

You will submit the superbill directly to your insurance company through their online portal or by mail. They will then process your claim and send you a reimbursement check for the percentage of the fee that your plan covers.

Deciding how to pay for therapy is a personal choice. Using out-of-network benefits offers significant advantages, but it's also important to understand the process. Here is a transparent look at the pros and cons to help you decide if it's the right fit for your situation.

Benefits for You

• You Have the Freedom to Choose: You are not limited to a small list of therapists dictated by your insurance plan. You can choose the therapist who is truly the best fit for your specific needs, personality, and therapeutic goals.

• Greater Privacy and Confidentiality: To be reimbursed by an insurance company, a therapist must provide them with your diagnosis. When in-network, insurance companies can also audit records or request your treatment notes to verify "medical necessity." By not involving them directly in your care, your personal health information remains more secure and confidential between you and me.

• You Are in Control of Your Care: Our treatment plan is determined by your unique needs, not by insurance company mandates. We can decide on the length, frequency, and style of therapy that works best for you, without needing approval from a third party.

• Potentially Shorter Wait Times: In-network providers are often in high demand and can have long waiting lists. By expanding your search to include out-of-network providers, you may be able to find a well-suited therapist and begin your sessions more quickly.

Things to Consider

• Higher Upfront Cost: You are responsible for paying my full fee at the time of each session. This can be a significant initial out-of-pocket expense while you wait for your insurance company to reimburse you.

• You Handle the Reimbursement Process: The responsibility for submitting claims and following up with your insurance company rests with you. You will need to send them the "superbill" I provide and manage the communication regarding your reimbursement.

• Navigating Deductibles and Rates: You must first pay your plan's annual out-of-network deductible out-of-pocket before your insurance will begin to reimburse you. Also, they may not cover my full fee; instead, they reimburse a percentage of what they determine is a "usual and customary rate," which can be lower than my actual fee.

• Reimbursement Is Not Guaranteed: While most PPO plans offer out-of-network benefits, it is not a guarantee of payment. Verifying your specific benefits with your insurance company beforehand is essential.