How to Use Out-of-Network Benefits for Therapy
Finding the right therapist is a personal process, and sometimes the provider you connect with most isn’t in your insurance network. The good news? Many insurance plans include out-of-network (OON) benefits that can help cover the cost of therapy, making it more affordable than you might think. Here’s a clear, step-by-step guide on how to use those benefits for mental health therapy.
Step 1: Call Your Insurance Company
Start by flipping over your insurance card and calling the customer service number. Ask specifically about out-of-network mental health coverage. Helpful questions to ask:
Do I have OON benefits for outpatient mental health therapy?
What percentage of the session fee will be reimbursed?
Do I have a deductible I need to meet first? If so, how much?
How many sessions per year are covered?
Do I need pre-authorization before starting therapy?
Write down the representative’s name and the date of your call for your records.
Step 2: Ask About “Superbills”
Most therapists who are out-of-network can provide you with a superbill—a detailed receipt with all the information your insurance company needs (session dates, fees, and diagnosis codes). You submit this document directly to your insurance company for reimbursement.
Step 3: Understand Deductibles and Reimbursement Rates
Here’s how it often works:
You pay your therapist’s full fee at the time of your session.
Your insurance company applies the cost toward your OON deductible.
Once the deductible is met, you may be reimbursed for a percentage of the session fee (commonly 50–80%).
For example, if your therapist charges $200 and your OON reimbursement rate is 70%, you could get $140 back per session after meeting your deductible.
Step 4: Submit Claims
Each insurance company has its own process. Some allow you to upload superbills directly to an online portal, while others require you to mail or fax them in. Ask about the fastest and most reliable method. See my resource page to learn more about different networks.
Step 5: Consider Using an App or Service
If the paperwork feels overwhelming, there are apps and services (like Reimbursify or Mentaya) that can submit superbills and track claims for you, making the process easier. I am not affiliated with these apps but they are options to explore.
Why Using OON Benefits can be Worth It
Choosing a therapist you trust and connect with can make a big difference in your healing process. Using your OON benefits allows you to prioritize the best therapeutic fit for your needs rather than limiting your choices to in-network providers.