In-network vs. out-of-network providers
Insurance companies negotiate set rates with therapists who join their in-network system. When you see an in-network provider, your insurance pays them directly according to that agreement, and you typically owe either a copay (a fixed dollar amount) or coinsurance (a percentage of the cost).
Any therapist who is not contracted with your insurance is considered out-of-network (OON). These providers set their own fees. Depending on your insurance plan, you may still be able to use OON benefits to get reimbursed for part of what you pay. Some plans also require you to meet an OON deductible before reimbursement begins.
How out-of-network benefits work
Many insurance plans offer reimbursement for sessions with out-of-network therapists. Unlike in-network care, you pay the full session fee upfront and then submit documentation to your insurance company.
Once your OON deductible is met, most plans reimburse 50–80% of the session cost. That means you ultimately pay 20–50% of the fee, depending on your plan.
Example: How reimbursement saves you money
Imagine your plan reimburses 60% of out-of-network therapy costs and has a $1,000 OON deductible.
- Before meeting your deductible, you pay the full session fee. For a $195 session, you pay $195.
- After meeting your deductible, you still pay $195 upfront, but you can submit a claim for reimbursement. At a 60% reimbursement rate, you’d receive $117 back. Your actual cost becomes $78 per session.
If your plan reimburses 80%, your cost drops even further — you’d pay $39 per session after reimbursement.
Also keep in mind: your OON deductible usually applies to all out-of-network services, not just therapy. If you meet your deductible earlier in the year through other medical expenses, your therapy sessions may be reimbursable right away.
Reimbursement amounts always depend on your specific plan and your insurance company’s policies.
What you should do
Because every insurance plan is different, you’ll need to check your specific benefits. Here’s how to get started:
- Confirm coverage: Ask your insurance provider whether out-of-network mental or behavioral health services are covered, and what your deductible and reimbursement rates are.
- Learn how to file claims: Log in to your insurance portal or call your insurer to find out what they require for OON claim submissions.
- Collect documentation: At the end of each month, you’ll receive a superbill listing all your sessions and the details your insurance needs.
- Submit your claim: Most insurance companies allow online claim submissions.
- Receive reimbursement: Your insurance company will send the reimbursement directly to you.
Remember, the exact process varies by plan.
Other ways to save
You can also use HSA or FSA funds to pay for therapy, which lets you use pre-tax dollars. If your employer offers special mental health benefits, those can often be applied as well.