Understanding Out-of-Network Therapy
As a therapist who works out-of-network, I want to help you understand what that means for your insurance and how to make the process smoother. Out-of-network (OON) coverage can feel confusing, but knowing what to ask and what to expect can make therapy more accessible for you and your family.
What Out-of-Network Coverage Means
Out-of-network means your insurance doesn’t have a contract with me. Some plans still offer partial reimbursement for OON therapy, though it’s usually less than in-network coverage and may involve deductibles or coinsurance. Checking your plan details in advance helps you understand what portion of therapy sessions might be covered.
Questions to Ask Your Insurance
Tip: Most insurance cards have a specific phone number for mental health or behavioral health benefits. Calling this line can help you get answers faster and more directly than the general member services number.
When calling your insurance company, here are some helpful questions to guide the conversation:
Does my plan cover out-of-network therapy sessions?
What is my deductible, and has it been met?
What percentage of the session fee will be reimbursed?
Are there limits to the number of OON sessions per year?
What paperwork or documentation do I need to submit, and how do I submit?
Getting Reimbursed
I provide a superbill, which is a detailed receipt with the service codes and diagnosis codes your insurance company needs. You submit this to your insurance for reimbursement. Keep in mind that it usually takes a few weeks, and you may only get partial reimbursement.
Tips to Make the Process Easier
Call your insurance before your first session to understand your coverage.
Keep all receipts and superbills organized.
Know your plan’s OON annual maximum to avoid surprises.
Navigating out of network therapy options doesn’t have to be stressful. By knowing what questions to ask and keeping good records, you can access the care you need while making the process as smooth as possible. I’m here to guide you and answer any questions about using your benefits with my practice.
