Using Your Out-of-Network Insurance Benefits
You Don't Have to Choose Between Great Therapy and Using Your Insurance
Many people think they have to pick: either use their insurance and see whoever's available, or pay out-of-pocket for the therapist they really want. But there's actually a third option that gives you the best of both worlds—using your out-of-network benefits.
What Are Out-of-Network Benefits?
Out-of-network benefits allow you to see any licensed therapist (like me), pay them directly, and then get reimbursed by your insurance company. Think of it like going to any doctor and submitting the receipt to your insurance afterward to get money back.
Here’s how it works:
You pay me directly at each session
I provide you with a detailed monthly receipt (often called a “superbill” by insurance carriers)
You submit the superbill to your insurance for reimbursement
Your insurance pays you back based on your specific benefits/plan
Why Choose Out-of-Network Therapy?
You Get to Choose Your Therapist
Instead of being limited to who’s in your network (and available), you can choose the therapist who’s actually the right fit for you.
No Insurance Driven Treatment Decisions
Your therapist can focus entirely on what you need, not what your insurance will approve or allow. Insurance companies often limit session frequency, dictate which therapeutic approaches can be used, require specific diagnoses for coverage, or set arbitrary session limits regardless of your actual progress. With out-of-network therapy, your therapist has the clinical freedom to use their expertise and training to provide exactly what serves you best–no pre-authorizations, no treatment limits, and no surprise denials after you’ve already started therapy.
Your Privacy Stays Private
With in-network therapy, your insurance company received detailed information about your diagnosis, treatment plans, and progress. They may also conduct audits requesting copies of your therapy notes. With out-of-network (like me), they only see basic information for reimbursement—dates of service, provider credentials, and general diagnostic codes. Your conversations, treatment plans, and personal details stay completely between you and your therapist.
Often More Affordable Than You Think
Many people are surprised by how much their insurance reimburses for out-of-network therapy. Depending on your plan, you might get anywhere from 50-80% back, making your actual cost quite reasonable for significantly better care.
Consistent, Uninterrupted Care
If you change jobs or insurance plans, you can keep seeing the same therapist. Your therapeutic relationship doesn't get disrupted by corporate decisions outside your control.
How to Check Your Out-of-Network Benefits?
You'll start by calling the member services number on the back of your insurance card, and ask to speak with a member service representative or healthcare advocate.
Key Questions to Ask Your Insurance Provider:
Does my plan cover outpatient mental health counseling/therapy? (Ask specifically about CPT Codes 90791 and 90837.)
Does my plan offer out-of-network benefits for mental health services?
Do I have an out-of-network deductible? If so:
How much is it?
How much has been met so far?
After I meet my deductible, what percentage of the session fee will be reimbursed? (For example, will they reimburse 50%, 60%, or another percentage?)
Are there any limitations to my coverage? (e.g., session limits, restrictions on telehealth, yearly maximums, etc.)
How do I submit claims for reimbursement?
Can I get a reference number for this call? (This is helpful in case you need to follow up or appeal a claim)
Each insurance plan is different so contacting your insurance carrier directly will be the best way to determine your OON benefits and coverage options.
Once you know your coverage percentage, you can calculate your actual cost. For example:
Session cost: $200
Insurance covers: 60% after deductible
Your cost: $120 per session after reimbursement
Note: Reimbursement rates typically range from 60-70% but vary significantly by plan. These are estimates only—your actual benefits may be different.
How It Works at My Practice
Getting Started
Once you've verified your benefits and decided to move forward, I make the process simple:
You'll pay your normal session rate at each appointment
I’ll upload detailed superbills to your client portal monthly
You download them and submit them to your insurance (most insurance companies now have online portals and mobile apps where you can simply upload photos of your superbills—no more mailing or faxing!)
Your reimbursement comes directly to you
Ongoing Support
I know insurance stuff can be confusing. If you run into any issues or need superbills more frequently, just let me know. I’m here to help and make this as smooth as possible.