Guides
Using out-of-network benefits for therapy
Out-of-network benefits can help with the cost of private pay therapy, as long as you know how the process works and what to ask.
The practical side
My practice is private pay, and I’m an out-of-network provider. That means I don’t bill insurance directly—but it doesn’t necessarily mean insurance plays no part. If your plan includes out-of-network mental health benefits, you may be able to get partial reimbursement for sessions. Here’s how that works, step by step.
What out-of-network means
Insurance companies sign contracts with a network of providers—they bill the insurer directly and accept its rates. Out-of-network providers, like me, don’t have that contract. You pay for sessions yourself, and then, if your plan allows it, you ask your insurer to reimburse part of the cost.
PPO plans often include some out-of-network coverage, while HMO and EPO plans often don’t. The only way to know for sure is to ask your insurer about your specific plan.
How superbills work
Payment is due at the time of each session, and I keep a card on file through a secure processor. On request, I provide a monthly superbill—an itemized receipt with the codes your insurer needs. You submit it to your plan yourself, and any reimbursement your plan allows is paid to you. The process usually looks like this:
- Pay for each session at the time of service.
- Ask for your monthly superbill.
- Submit it to your insurer, often through their online portal or by email.
- Receive whatever reimbursement your plan’s coverage allows.
Questions to ask your insurer
Before we begin, it’s worth calling the number on your insurance card. These questions will get you most of the way:
- Do I have out-of-network outpatient mental health benefits?
- What’s my out-of-network deductible, and how much of it have I met?
- What percentage of the session fee is reimbursed once it’s met?
- Is there a limit on the number of sessions per year?
- How do I submit a claim for reimbursement?
The diagnosis trade-off
A superbill does require a mental health diagnosis to be recorded, because that’s what insurers reimburse against. You might be comfortable with that. Or you might rather not have a diagnosis sitting in an insurance file—in which case paying privately without submitting anything is an entirely reasonable decision.
There’s no right answer here, and we can talk it through on a consultation call before you decide. Reimbursement is between you and your insurer, and the amount depends on your plan rather than on me. I can’t promise any particular outcome, but I’m happy to help you navigate the process.
Why I stay private pay
When an insurer pays, it also gets a say: usually a diagnosis on your record from the start, periodic checks on whether your care still counts as medically necessary, and pressure toward shorter, protocol-shaped treatment. Staying out of network keeps those decisions between us. It also lets me keep a small caseload, so each person gets real attention.
I know private pay puts therapy out of reach for some people, and I’d rather say that plainly. If cost is the barrier, say so on our consultation call, and I’ll point you toward lower-fee and sliding-scale directories in your state.
Before we begin, you’ll also receive a written Good Faith Estimate of expected costs. The full details of fees, superbills and cancellations are on my rates page, and the FAQ covers the most common insurance questions. When you’re ready, you can request a free 15-minute consultation.
A few common questions
Will my insurance cover therapy with you?
I don’t bill insurance directly, so coverage depends on whether your plan has out-of-network mental health benefits. If it does, you may be able to get partial reimbursement using a superbill. Your insurer is the only one who can tell you for sure.
Does insurance reimburse missed sessions?
No. Insurance doesn’t reimburse missed sessions, and under my 48-hour cancellation policy a late cancellation or missed session is charged the full session fee. My practice policies have the details.
Can you submit claims for me?
I don’t bill insurance directly, so you’ll submit the superbill yourself. I’m happy to answer questions about it, though, and calling your insurer with the questions above is the best first step.