How to Use Out-of-Network Benefits for Therapy (And Why It Might Be Easier Than You Think)
If your therapist isn’t in-network with your insurance company, that doesn’t necessarily mean you have to pay for therapy entirely out of pocket. Many insurance plans include out-of-network benefits, which can help you get reimbursed for a portion of your therapy costs—even if your therapist isn’t officially listed as a provider.
It’s not always well advertised, and it can feel a little confusing at first—but once you know how it works, it’s actually a pretty straightforward process.
Here’s what you need to know.
What Are Out-of-Network (OON) Benefits?
Out-of-network benefits are part of your insurance plan that allow you to work with providers who aren’t “in-network”—meaning your therapist doesn’t have a direct contract with your insurance company.
Instead of paying a small co-pay like you would in-network, you typically pay the full session fee up front, and then submit a claim to your insurance company for partial reimbursement.
Depending on your plan, you may be reimbursed for 50–80% of the session cost.
How It Works (Step-by-Step)
Ask your insurance provider the right questions
Call the number on the back of your card and ask:
“Do I have out-of-network benefits for outpatient mental health?”
“What is my deductible, and how much have I met?”
“What percentage is reimbursed after I meet my deductible?”
“Are there any limits on the number of sessions per year?”
“Do I need pre-authorization?”
Pay for sessions directly
You’ll pay your therapist their full fee (for example, $150 for individual therapy).
Receive a “Superbill”
Your therapist will provide you with a superbill—a receipt that includes the necessary information (diagnosis code, CPT code, dates of service, provider info).
Submit the superbill to your insurance company
Each insurer has their own process. Some allow online submission through a member portal; others require a claim form.
Receive reimbursement
Once processed, your insurance company will send you a check for the eligible portion of the session cost.
What’s the Catch?
You’ll likely need to meet your deductible before reimbursement begins.
There may be a delay between submitting claims and receiving payment.
Some plans only reimburse for sessions with a formal diagnosis (though this is true for in-network providers as well).
That said, many clients successfully use OON benefits as a way to work with the therapist they feel most connected to—without shouldering the full cost long term.
I’m Happy to Help
If you’re interested in working together but unsure about insurance or reimbursement, I’m here to support you. I can provide all the documentation you need and walk you through the process if it feels unfamiliar. You don’t have to figure it out alone.
Curious if out-of-network therapy might be a good fit for you?
Book a free consultation, and let’s talk through your options—no pressure, just clarity.
