Understanding Out-of-Network Benefits for Psychotherapy: What You Need to Know
Understanding Out-of-Network Benefits for Psychotherapy:
What they are, how they work, and how to make the most of your insurance reimbursement
Deciding to start therapy is an important investment in your well-being.
But if your therapist is considered “out-of-network” with your insurance, you might wonder—Can I still get reimbursed? The good news is: yes, you often can.
This post will guide you through what out-of-network benefits are, how they work, and how to take advantage of them when working with a therapist who is not in-network with your plan.
What Are Out-of-Network Benefits?
Your insurance company typically offers two types of coverage:
In-network providers have a contract with your insurance company.
Out-of-network providers do not—but your plan may still cover a portion of the cost.
Most PPO (Preferred Provider Organization) plans offer out-of-network coverage. HMO plans usually do not, so it’s important to check with your insurer directly.
How Reimbursement Works
When you work with an out-of-network therapist:
You pay the therapist directly.
You receive a superbill—a detailed receipt with the necessary info for insurance.
You submit the superbill to your insurance company.
You receive reimbursement (usually a percentage) after your deductible is met.
Many clients receive 50–80% back depending on their plan and deductible.
Schedule a free consultation to have your benefits verified instantly.
Key Terms to Know
Deductible: The amount you must pay out-of-pocket before your insurance starts reimbursing.
Coinsurance: The portion of the fee you’re responsible for (e.g., 20%).
Superbill: A detailed document provided by your therapist to submit to your insurance.
Out-of-pocket maximum: The maximum amount you’ll pay in a year before your insurance covers 100%.
Tips to Maximize Your Out-of-Network Benefits
Call your insurance company and ask:
Do I have out-of-network mental health benefits?
What’s my deductible and how much has been met?
What percentage of the session fee will be reimbursed?
How do I submit a claim?
Is there a session limit per year?
Use HSA/FSA: Therapy is typically an eligible expense.
Call Catsam Wellness Therapy to have your benefits verified instantly.
Why Some Therapists Remain Out-of-Network
Being out-of-network allows therapists to:
Offer more flexibility and autonomy in treatment.
Limit insurance company involvement in care.
Avoid billing restrictions and reduced reimbursement rates—benefiting both therapist and client.
Final Thoughts
Out-of-network therapy doesn’t mean therapy is out of reach.
With a little preparation and a clear understanding of your insurance benefits, you can receive quality care and get reimbursed.
Have questions? At Catsam Wellness Therapy, I’m happy to walk you through using your out-of-network benefits—just ask.
