Out-of-Network Reimbursement Guide
Braxy Speech Therapy is out-of-network with commercial insurance plans. We’ve intentionally opted out because insurance guidelines often limit session frequency, treatment goals, and definitions of progress—restricting the individualized, play-based care we believe every child deserves.
Wondering how to get reimbursed for therapy if we're out-of-network? Here's a quick guide to superbills, out-of-network benefits, and how to submit for insurance reimbursement step by step.
What is "Out-of-Network" Coverage?
If we’re not in-network with your insurance, you may still get reimbursed for part of what you pay—this is called out-of-network coverage.
Every plan is different, but many PPO plans reimburse a percentage of therapy costs after you meet your out-of-network deductible.
📝 Example:
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You pay $100 per session.
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Your plan reimburses 60% after a $500 deductible.
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Once you hit that deductible, you might get $60 back per session.
What is a Superbill?
A superbill is like a detailed receipt for therapy services. It includes all the important information your insurance company needs to consider reimbursing you for sessions with an out-of-network provider (like us!).
It includes:
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Therapist credentials
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CPT billing codes
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Diagnosis code (if applicable)
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Session dates and times
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Total cost paid
Think of it as your proof of payment + documentation of care.
How to Use a Superbill (Step-by-Step)
1. Call Your Insurance Company
Call the member number on your insurance card and ask these questions:
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“Do I have out-of-network benefits for speech therapy?”
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“Is a diagnosis code required?”
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“What percentage do you reimburse?”
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“Is there a deductible? If so, how much is it?”
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“How do I submit a superbill?”
2. Save Your Superbills
We’ll send them monthly (or as requested). They’ll come from your therapist or our admin team via email or portal.
3. Submit Your Claim
Most insurance companies let you do this by:
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Uploading via member portal, or
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By emailing, faxing, or mailing a form + your superbill
You may need to fill out a Member Reimbursement Form, which can be found on your insurance company's website.
4. Track Your Submission
Keep notes or screenshots of what you sent. Mark your calendar to check for updates in 2–4 weeks.
5. Watch for Reimbursement
If approved, a check or direct deposit will come from your insurance—not from us.
If denied, call your insurance company and ask for clarification—you may be able to appeal.