Out of Network Benefits

Out-of-network benefits refer to insurance coverage for services provided by a clinician or therapist who is not contracted directly with your insurance plan. While in-network providers have a negotiated rate with your insurance company, out-of-network providers set their own rates, and your insurance may still reimburse you for a portion of the cost—depending on your plan.

Here’s how it generally works for mental health appointments and therapy:

1. Using Out-of-Network Benefits for Therapy

If your therapist doesn't accept your insurance directly, you may still be able to:

  • Pay the full session fee upfront

  • Request a "superbill" (a detailed receipt with necessary information)

  • Submit the superbill to your insurance for reimbursement

2. What Insurance Typically Covers

Your reimbursement depends on:

  • Whether your plan includes out-of-network mental health coverage

  • Your deductible (the amount you need to pay out-of-pocket before insurance starts reimbursing)

  • The percentage your plan reimburses after the deductible is met (often 50–80%)

3. Important Things to Check With Your Insurance

  • Do I have out-of-network mental health benefits?

  • What is my deductible, and how much of it have I met?

  • What percentage of the session cost will be reimbursed?

  • Is there a limit to the number of sessions per year?

  • Do I need pre-authorization?.