A Step-by-Step Guide
We are an out-of-network provider in FL, CT, TX, NJ (states where Katie Ziskind is licensed as a licensed marriage and family therapist), which means:
- You pay for sessions directly (HSA/FSA, credit, or debit)
- We provide you with a superbill (medical receipt) and diagnosis on the first session unless you tell us otherwise
- You are responsible for submitting claims and communicating with your insurance company
1: Understand Your Out-of-Network Benefits
Before submitting anything, call your insurance company and ask:
Questions to Ask:
- Do I have out-of-network mental health benefits?
- What is my deductible, and has it been met?
- What is my reimbursement rate (e.g., 80%)?
- Is pre-authorization required?
- Where do I submit superbills (online portal, email, or mail)?
- What do you reimburse for these CPT billing codes?
- Remove the 95 on the end of the code if you are meeting in person.
- First session – 90791-95.
- 45-50 min individual – 90834-95.
- 53+ min individual – 90837-95
- Family/couples (more than one family member present) – 90847-95.
Other info you’ll need:
- Our tax ID is 82-4294395.
- Katie Ziskind’s NPI 1316439995
- Florida LMFT License: MT4371
- Connecticut LMFT License: 0001996
- New Jersey LMFT License: 37FI00224700
- Texas LMFT License: 206443
👉 Write down:
- Representative’s name
- Date/time of call
- Reference number (if provided)
2: Submit Your Superbill
You will receive a superbill after payment on the 1st of each month. Text us at 1-860-451-9364 if you’d like one more frequently.
Submit via:
- Insurance portal (fastest)
- Email or fax
- Mail (slowest)
Include:
- Superbill
- Claim form (if required by your insurance) – Be sure to check the box that states you have already paid us as the provider, so the reimbursement goes back to you.
👉 Keep copies of everything you submit
3: Track Your Claim
- Processing usually takes 2–6 weeks
- Log into your insurance portal weekly
- Look for:
- Claim status
- Explanation of Benefits (EOB)
4: If Your Claim Is DENIED
This is common and does NOT mean final denial.
First, call your insurance and ask:
- Why was this denied?
- Is this a coding issue, or missing info? (Be sure you are submitting the superbill and not an invoice.) If your superbill needs a code edit, text Katie Ziskind at 1-860-451-9364.
- Benefit limitation?
- What is needed to reprocess the claim?
👉 Take notes during every call
5: Advocate for Reprocessing
Use clear, direct language:
What to say:
- “I am requesting a claim reprocessing.”
- “I have out-of-network benefits and would like this reviewed again.”
- “Please explain exactly what is missing so I can resubmit.”
If needed:
- Resubmit the superbill
- Attach any requested documentation
6: Request a Single Case Agreement (SCA)
(When no in-network providers meet your needs)
You may qualify if:
- No schedule availability with in-network therapists
- No in-network therapists with the speciality you need
- Long waitlists
- Need a highly specialized provider (trauma, couples, sex informed therapy, etc.)
Call insurance and say:
- “I am requesting a single case agreement due to lack of in-network providers.”
- “I need access to specialized care that is not available in-network.”
7: Know Your Rights
Insurance companies are legally required to:
1. Provide a “Network Adequacy”
They must have:
- Enough providers
- Reasonable wait times
- Appropriate specialties
2. Offer Access to Care
If they cannot meet your needs:
👉 They are required to cover out-of-network care at in-network rates
8: File an Appeal (If Needed)
If denied again:
Request:
- “How do I file an appeal?”
Include:
- Superbill
- A written statement (you can write this yourself)
- Explanation of why care is medically necessary
9: Escalate If Necessary
If you’re not getting support:
Ask for:
- A supervisor
- A case manager
You can also:
- File a complaint with your state’s Department of Insurance
Helpful Tips
✔ Be persistent — multiple calls are normal
✔ Stay calm, clear, and assertive
✔ Keep a log of every interaction
✔ Use phrases like:
- “I’d like this documented in my file”
- “Can you provide that in writing?”
What We Can (and Cannot) Do
We ARE happy to:
✔ Provide accurate superbills
✔ Offer documentation if needed
✔ Provide a short letter as to why specialized services are medically necessary
Wisdom Within Counseling and Coaching does not:
- Call insurance companies on your behalf
- Guarantee reimbursement
- Negotiate claims directly
You Can Successfully Navigate This
While insurance can feel overwhelming, many clients receive reimbursement by:
- Following up consistently
- Asking clear, direct questions
- Advocating for their needs
You deserve access to specialized, high-quality care—and we’re here to support you every step of the way.
Ready to Begin?
Contact Wisdom Within Counseling today to schedule your first session—in person in Melbourne, Florida, or Niantic, Connecticut, or via telehealth.
