Wondering how to use your insurance for therapy with an out-of-network provider?
You’ve decided you’d like to start therapy. You’ve done your homework and found a therapist you’re excited to work with. You’re hoping to use your insurance for therapy. But then… you realize they are an out-of-network provider (they don’t work with your insurance).
I have some good news: many insurance plans offer mental health benefits for this exact scenario. Depending on your plan, you may be eligible for partial reimbursement for therapy that you pay for out-of-pocket.
With therapy often ranging from $150 – $250 (or more!) per session, many of us could use some help from insurance to help make regular sessions more financially sustainable. If that’s you, you’re in good company.
Figuring out how to use your insurance for therapy may seem overwhelming, but it doesn’t have to be.
In the three steps below, I break down how to use your insurance for therapy when your best-fit therapist is out-of-network.
Step One: Contact your insurance company to verify your benefits.
Call the phone number on your insurance card and let them know you’d like to learn more about your mental health coverage. Your call will be directed to someone who can answer your questions.
I suggest you ask the following questions:
- Do I have coverage for services with an out-of-network mental health provider?
- Do I have coverage for therapy that is provided online?
- What is my deductible? (Or, what amount am I financially responsible for before my benefits kick in?)
- How much of my deductible have I already met?
- How much will I be reimbursed per therapy session?
- How many sessions are covered per year?
- Am I required to have a mental health diagnosis in order to receive reimbursement?
- What is the process for requesting reimbursement?
- Is there anything else I should know about my coverage for seeing an out-of-network mental health provider?
This should give you a better sense of whether it’s financially sustainable for you to meet with your desired out-of-network therapist. If you decide that it is NOT financially sustainable, know you have options for meeting your mental health care needs. Click here to learn how to find providers that work with your insurance or offer sessions at a reduced-rate/for free.
If you are comfortable with your out-of-network benefits and ready to take the next step, read on.
Step Two: Pay for therapy out-of-pocket and request a superbill from your therapist.
Assuming you have coverage for out-of-network mental health services, your insurance representative most likely explained that you will need to submit a “superbill” in order to request reimbursement. A superbill is a document that outlines information about you, your provider, services received, and your mental health diagnosis (if applicable).
In my own practice, superbills for current clients can be found in my secure client portal. After signing in, click Menu → Billing & Payments → Insurance Reimbursement Statements. There you will find all of your superbills ready to download.
Be sure to review your superbills to ensure that all of your information is correct and complete in order to avoid delays in reimbursement (sometimes insurance will kick back paperwork if there is incorrect or missing information).
Step Three: Submit superbills to insurance for reimbursement.
Next you’ll follow instructions you received from your insurance representative for requesting reimbursement. This typically involves mailing your superbills to an address they provide. If you prefer, you can also use an app like Reimbursify to submit your claims online. Then, just wait for your check to arrive!
Still have questions about how to use your insurance for therapy with an out-of-network provider?
Let’s get in touch! If you are a prospective client with additional questions about how to navigate insurance with an out-of-network provider like myself, reach out for a virtual consultation. We can discuss your questions in more detail and I’ll do my best to walk you through the process. Current clients, feel free to bring additional questions to our next session or message me directly through our secure client portal.