How to Use Out-of-Network Therapy Benefits: A Simple Guide

If you are considering therapy, navigating insurance shouldn’t stand between you and getting the right support. Many people don’t realize that even if a therapist does not bill their insurance company directly, their health plan may still cover a significant portion of the cost.

What Does Out-of-Network (OON) Therapy Mean?

An out-of-network provider is a therapist who does not contract directly with insurance companies. Instead of the therapist billing your insurance company directly, you pay the therapist at the time of service, and your insurance company may reimburse you for a percentage of that fee afterward.

Why Choose an Out-of-Network Therapist?

  • Specialized Care: You can choose a provider based on expertise, personality, and fit—rather than choosing strictly from an insurance directory list.

  • Privacy & Control: You and your therapist control your care, session frequency, and treatment plan without strict limitations from insurance companies.

  • Flexibility: Many preferred providers offer tailored care that fully aligns with your goals.

4 Simple Steps to Use Your Out-of-Network Mental Health Benefits

Using your OON benefits is easier than it sounds. Here is how the process works from start to finish:

[ Step 1: Call Your Insurance ] ➔ [ Step 2: Attend Your Session ] ➔ [ Step 3: Receive Your Superbill ] ➔ [ Step 4: Get Reimbursed ]

1. Call Your Insurance Carrier

Before your first session, call the customer service number on the back of your insurance card (usually under "Mental Health" or "Behavioral Health"). Ask the representative the specific questions listed in the section below.

2. Attend Your Therapy Session

Pay for your session at the time of service using cash, check, credit card, or your HSA/FSA account.

3. Receive Your Monthly Superbill

At the end of each month, your therapist can provide a superbill (an itemized receipt for medical services) upon request, typically delivered securely through your client portal.

4. Submit Your Superbill for Reimbursement

Upload your superbill to your insurance company’s member portal or submit it via mail/app (I partner with Mentaya which can also automate this for you). Your insurance company will process the claim and send a reimbursement check directly to you.

Need to Understand your OON Benefits? Questions to Ask Your Insurance Provider

When you call your insurance company, use this script to get clear details on your coverage:

  • "Do I have out-of-network mental health benefits for outpatient psychotherapy?"

  • "What is my out-of-network deductible, and how much of it has been met this year?"

  • "What percentage of the fee is reimbursed after I meet my deductible?" (e.g., 60%, 70%, 80%)

  • "Is there a maximum allowed amount for CPT code 90837 (50-minute individual therapy)?"

  • "How do I submit superbills for reimbursement?"

Frequently Asked Questions About Out-of-Network Therapy

Are out-of-network therapy fees guaranteed to be reimbursed?

No. Reimbursement depends entirely on your specific insurance policy, deductible status, and coverage rules. It is always best to verify your benefits with your carrier before starting care.

What information is included on a superbill?

A superbill includes essential clinical details required by insurance companies to process claims, including provider information, service dates, procedure codes (CPT codes), standard fees paid, and a mental health diagnosis code (ICD-10 code).

Is out-of-network therapy worth it?

For many clients, yes. Working with an out-of-network therapist gives you greater control over your care, greater privacy, and the freedom to find a provider who is the absolute best clinical match for your needs.

What is the next step?

If you have questions about therapy fees or getting started, reach out today to schedule a consultation.