Paying for therapy can be confusing, especially when your therapist isn’t in your insurance network. Many people feel unsure about what to do or where to start. If that’s you, you’re not alone—and this guide will help make things much clearer.
If you’ve been wondering how do out-of-network benefits work, here’s a simple answer: You pay your therapist directly, then send a special receipt (called a superbill) to your insurance company. If your plan includes out-of-network coverage, they may pay you back for part of the cost. It’s a helpful way to get support from the therapist who’s the best fit for you—even if they’re not in your insurance network.
My goal is to walk you through this step-by-step so you don’t feel overwhelmed. Whether you’re just getting started or thinking about switching therapists, I’m here to make the process feel easier. You deserve support—and understanding how your benefits work is one way to get it.
What Does “Out-of-Network” Mean for Therapy?
When we talk about health insurance, the term “in-network” means that a therapist has a contract with your insurance company. This usually means your insurance pays the therapist directly, and you only pay a small part, called a copay. It’s kind of like going to a restaurant that accepts your gift card—you hand it over, and they take care of most of the cost.
Out-of-network means the therapist does not have a contract with your insurance company. But that doesn’t mean your insurance won’t help at all. Instead, you pay the therapist up front, and then your insurance might pay you back later. These therapists are called out-of-network providers, and getting reimbursed is possible—you just have to ask your insurance company and follow a few steps to get that money back.
Here’s a quick example: Let’s say your therapist charges $150 per session. If your insurance covers 70% for out-of-network care, you could get $105 back after you send in your receipt. That means your session really only cost you $45 in the end. While you’ll have some out-of-pocket costs at first, many clients find it’s worth it. It may sound tricky at first, but once you do it once or twice, it becomes easier to understand—and it opens the door to working with the therapist who feels right for you.
How Do Out-of-Network Benefits Work, Step-by-Step?
Using out-of-network benefits can feel confusing at first, but it really comes down to just a few simple steps. If you’ve ever wondered how out-of-network benefits work, here’s a clear and easy way to understand it.
Each part of the process is something you can do, and you don’t have to do it alone. Your therapist or their office may even be able to guide you through it. Let’s walk through it together.
Step 1: You Pay Your Therapist Up Front
Since your therapist is considered an out-of-network provider, they won’t bill your insurance directly. That means you’ll pay out of pocket for the full session fee at the time of your visit—kind of like paying for a haircut or a dentist appointment.
If your therapist charges $150, you would pay the bill right away. But don’t worry—this isn’t the final step. If your health plan includes out-of-network coverage, your insurer may reimburse you for part of the cost, based on their allowed amount for covered services.
Step 2: You Get a Receipt (Also Called a Superbill)
After your session, your therapist can give you a special receipt called a superbill. It’s not just any receipt—it has the important details your insurance company needs to process your claim.
The superbill includes your name, the date of your session, the therapist’s info, the type of service, and how much you paid. Most therapists are used to providing this, so just ask if you’re not sure.
Step 3: You Submit That to Your Insurance Company
Once you have your superbill, you send it to your insurance company. Some companies let you upload it online. Others may need you to mail it in or fax it. Depending on the company, they may have a claim form that they want you to fill out to submit with your superbill.
If this part feels overwhelming, that’s okay. You can call your insurance company and ask, “How do I submit a superbill for out-of-network therapy?” They’ll walk you through the steps.
Step 4: You May Get Reimbursed for a Portion of the Cost
If your insurance plan covers out-of-network benefits and you’ve met your deductible, they’ll send you a payment. This is called reimbursement.
Let’s say your insurance covers 70%—you may get $105 back from a $150 session. That means you only paid $45 in the end. It’s a helpful way to make therapy more affordable, even if your therapist isn’t in-network.
How Can I Check If I Have Out-of-Network Benefits?
The best way to find out if your insurance helps with out-of-network therapy is to either check your plan online or call the number on the back of your insurance card. Many insurance companies have a member portal where you can log in and look at your mental health coverage. But if that feels confusing, it’s totally okay to call and ask.
When you speak with someone, it helps to ask clear and simple questions. Here are three good ones to try:
- “Do I have out-of-network benefits for mental health or therapy? ”
- “What percentage of the cost do you reimburse? ”
- “Is there a deductible I need to meet first? ”
Be sure to write down what they tell you. You can also ask if there’s a limit on how many sessions are covered or if they need any forms from your therapist. Don’t be afraid to ask questions—insurance can be tricky, but you’re allowed to get help understanding it.
What Is a Superbill, and How Do I Get One?
A superbill is a special receipt your therapist gives you after a session. It has all the details your insurance company needs to pay you back. Think of it like a receipt with extra information—your name, the date of your session, what the session was for, and how much you paid.
Most therapists who work out-of-network are used to giving superbills. All you have to do is ask! You can say, “Can you give me a superbill so I can send it to my insurance? ” Some therapists give one after each session, and others can send it once a month.
If this is your first time doing this, it’s okay to feel unsure. You don’t have to know everything. Your therapist can help explain the process and make sure the superbill includes what your insurance needs. You’re not alone—this is something many clients ask for, and it’s a simple step toward getting support.
How Much Will I Be Reimbursed?
Every insurance plan is different, but most will pay you back for 50% to 80% of the cost of therapy if you have out-of-network benefits. That means if your session costs $150, you might get back anywhere from $75 to $120. The exact amount depends on your plan.
Some plans only start paying after you meet something called a deductible. This is a set amount you have to pay out-of-pocket first. For example, if your deductible is $500, your insurance might not start reimbursing you until you’ve spent that amount on care, including therapy.
It’s always a good idea to call your insurance company and ask what they’ll cover. Ask them to explain your out-of-network benefits and what your deductible is. Once you know the numbers, it becomes much easier to plan and feel confident about using your benefits.
Utilizing Out-of-Network Benefits Can Actually Give You More Freedom in Therapy
When you only use in-network providers, your choices can be limited. Sometimes, the therapists on the list don’t have openings, or they may not specialize in what you’re looking for. Using out-of-network benefits opens the door to more options.
You can choose a therapist who really fits your needs, values, and goals. Maybe you want someone who shares your faith, understands trauma, or works in a style that feels right for you. Out-of-network benefits help you find the right person, not just someone who happens to be on a list.
Therapy is a big step and an investment in your healing. Using your out-of-network benefits can make it easier to see the therapist you feel most comfortable with. It’s one more way to get the care you deserve, on your terms.
Final Thoughts
If you’re feeling unsure or stuck about how to use your insurance for therapy, please don’t give up. Out-of-network benefits may feel confusing at first, but many people use them every day to get the help they need. You don’t have to figure it all out alone—there’s support available for every step.
If you’re ready to start therapy but have questions about using your benefits, feel free to reach out. I’m happy to explain the process, help with a superbill, or just talk it through with you. You deserve care that fits you—and there is a way to make it work.
Until next time,
