How To Navigate Your Out Of Network Insurance Benefits
You’ve found a therapist who seems like they might be a really good fit. Maybe a friend recommended them, maybe you found their website, or maybe something about their training and approach just feels aligned with what you’re looking for.
And then you realize they don’t take your insurance.
I know that can feel discouraging, especially when you’re already doing the emotional work of trying to find support. But it does not necessarily mean you cannot work with that therapist. Many psychologists and therapists provide services as out-of-network providers, which means they do not bill insurance directly, but they can provide a superbill that you may be able to submit to your insurance company for possible reimbursement.
This process can feel confusing at first, so the goal of this article is to walk you through the basics: how to find out whether you have out-of-network benefits, what questions to ask your insurance company, and how superbills typically work.
My goal is not to make insurance more complicated than it already is. It is to help you understand your options so you can make an informed decision about your care.
Step 1: Do I Have Out Of Network Insurance Benefits?
The first step is finding out whether your insurance plan includes out-of-network mental health benefits.
In general, PPO and POS plans are the most likely to include out-of-network coverage. HMO and EPO plans often do not, although every plan is different, so it’s important to verify directly with your insurance company.
The easiest way to check is to call the customer service number on the back of your insurance card and ask:
Do I have out-of-network mental health benefits?
Do I have an out-of-network deductible?
What percentage do you reimburse after the deductible is met?
Is preauthorization required for outpatient psychotherapy?
Is there an “allowed amount” for CPT codes 90837 or 90834?
(Those are common billing codes for psychotherapy sessions.)
If your plan does not include out-of-network benefits, you still have the option to self-pay for therapy if that feels financially feasible for you. Some clients choose this route because they want a therapist with a particular specialty, training background, or treatment approach.
You can also typically use HSA or FSA funds for psychotherapy expenses, including out-of-network therapy. Many people are surprised to learn that these accounts can often be used for mental health treatment.
Step 2: Do I Have An Out Of Network Deductible?
An out-of-network deductible is the amount you must pay out of pocket before your insurance company begins reimbursing you for covered out-of-network services.
For example, if your out-of-network deductible is $2,000, you would first need to pay that amount toward eligible medical or mental health expenses before reimbursement begins.
When speaking with your insurance company, it can be helpful to ask:
What is my out-of-network deductible?
How much of it has already been met this year?
Does the deductible apply separately to mental health services?
Not all insurance plans have out-of-network deductibles, and some plans combine medical and mental health deductibles together. Because insurance policies can vary significantly, it’s always a good idea to confirm the details directly with your carrier.
Step 3: Do I Have Co-Insurance for Out-of-Network Therapy?
After you meet your out-of-network deductible, your insurance plan may begin reimbursing a percentage of the session cost. This is called co-insurance.
For example, if your insurance plan reimburses 70% of out-of-network psychotherapy services, you would be responsible for the remaining 30%.
It’s important to remember that reimbursement is usually based on the insurance company’s “allowed amount” for a service, not necessarily the therapist’s full fee. We’ll discuss that in the next section because it can significantly impact reimbursement amounts.
When you contact your insurance company, ask:
What is my out-of-network co-insurance percentage for outpatient mental health treatment?
Does this apply after I meet my deductible?
How are reimbursement amounts calculated for psychotherapy services?
Insurance terminology can feel overwhelming at first, but once you understand your deductible, co-insurance, and allowed amount, it becomes much easier to estimate your potential reimbursement.
Step 4: What Is an “Allowed Amount”?
The allowed amount is the maximum amount your insurance company considers eligible for reimbursement for a particular service.
This is important because insurance companies do not necessarily base reimbursement on your therapist’s full fee. Instead, they often calculate reimbursement using their own internal rate for a psychotherapy session.
For example:
A therapist’s fee may be $250 per session
Your insurance company’s allowed amount may be $150
If your plan reimburses 70% out of network, the reimbursement would typically be based on the $150 allowed amount, not the full $250 fee
In this example, the insurance company would reimburse 70% of $150 after any deductible requirements are met.
When you speak with your insurance company, ask:
What is the allowed amount for CPT code 90837 or 90834?
How much do you typically reimburse for out-of-network psychotherapy sessions?
Are reimbursements sent directly to me or to the provider?
Understanding the allowed amount can help you estimate your potential out-of-pocket costs more realistically before beginning therapy.
Understanding Your Potential Costs
Once you know:
whether you have out-of-network benefits,
whether you have a deductible,
your co-insurance percentage, and
the insurance company’s allowed amount,
you’ll have a much clearer picture of what therapy may realistically cost you out of pocket.
At that point, you can decide whether using your out-of-network benefits feels financially manageable and whether the therapist you’re considering feels like the right fit for your needs.
Many clients find that while the insurance process can initially feel a little confusing, it becomes much easier after submitting the first few claims. Some clients also choose to use services such as Reimbursify or Thrizer to help simplify superbill submission and reimbursement tracking.
Ultimately, the goal is to help you access care that feels clinically appropriate, supportive, and sustainable for you.
Free Out-of-Network Reimbursement Worksheet
If you’d like help organizing the information from your insurance company, you can download the free Out-of-Network Therapy Reimbursement Worksheet below.
Why Many Therapists Choose to Work Out of Network
One of the reasons many psychologists and therapists choose to work out of network is because it allows for greater flexibility and independence in treatment planning.
Insurance companies often place limitations on care, including how sessions are authorized, how diagnoses are documented, or how treatment progress is evaluated. Working outside of insurance panels can allow therapists to make clinical decisions based more fully on the needs of the individual client rather than on insurance requirements.
For many clients, this also creates a greater sense of privacy and autonomy in their care. Depending on the insurance plan, using in-network benefits may require a mental health diagnosis to be submitted and stored within the insurance system. Some clients are comfortable with that, while others prefer to keep their treatment more private.
Out-of-network therapy can also allow therapists to maintain smaller caseloads and dedicate additional time to specialized training, consultation, documentation, and treatment planning. This can be especially important in areas like trauma therapy, EMDR, dissociation, and complex mental health treatment, where therapy often requires a high level of focus and preparation.
That does not mean excellent care cannot exist within insurance-based systems. There are many highly skilled therapists who work in-network and provide outstanding treatment. Ultimately, the most important factor is finding a therapist who feels like a good clinical and relational fit for your needs.
The Importance of Presence in Trauma Therapy
Trauma therapy requires a high level of emotional presence, focus, and clinical attunement. Whether you are beginning therapy for PTSD, anxiety, dissociation, relationship concerns, or burnout, you deserve to work with someone who is fully engaged in the process with you.
Many therapists who work out of network intentionally maintain smaller caseloads so they can dedicate more time and energy to each client, including treatment planning, documentation, consultation, continuing education, and staying current with emerging research.
This can be especially important in specialized treatment approaches such as EMDR therapy, where sessions often involve careful pacing, preparation, and ongoing assessment of how a client is responding to treatment.
Therapy is a deeply personal process. Feeling emotionally safe, understood, and connected with your therapist matters. Beyond credentials and insurance panels, one of the most important factors in successful treatment is the quality of the therapeutic relationship itself.
Beginning Therapy With an Out-of-Network Provider
If you decide to move forward with an out-of-network therapist, the process is usually fairly straightforward.
In most cases, you will pay your therapist directly at the time of the session. Your therapist will then provide you with a superbill, which is a specialized receipt containing the information your insurance company may require for reimbursement.
You can then submit the superbill to your insurance company yourself, or use a reimbursement service such as Reimbursify or Thrizer to help simplify the process.
Once the claim is processed, your insurance company may reimburse you directly according to your specific out-of-network benefits, deductible, co-insurance, and allowed amount.
While the process can feel unfamiliar at first, many clients find that it becomes much easier after the first few submissions. For many people, the ability to work with a therapist who feels like the right clinical and relational fit ultimately outweighs the extra administrative steps involved.
If you’d like to learn more and see whether it feels like a good fit, click the button below to book a consultation.
