Out-of-Network Benefits: How They Work and How to Use Them
You've been looking for a therapist who takes your insurance and keep hitting roadblocks. I get it. I've been there myself. Finding someone who feels like a good fit and is covered can feel impossible, especially in areas where relatively few therapists accept insurance at all. The full out-of-pocket cost feels out of reach, and reduced options with the right fit haven't panned out either.
Before you give up on therapy, check your out-of-network benefits. They might open up more options than you realize.
What Out-of-Network Benefits Actually Are
Insurance companies contract with providers who are designated as "in-network." Those providers agree to a specific set of fees and a certain level of insurer oversight. Many therapists (myself included) aren't contracted with every insurer, but that doesn't necessarily mean your insurance won't help with the cost.
Many plans will reimburse you for a portion of what you pay to see an out-of-network therapist. The catch: not all plans include this, and the coverage varies widely. Here's how to find out what you have.
How to Find Out If You Have Out-of-Network Benefits
Check your Summary of Benefits. Most insurance companies send one out before each plan renewal period. Look for a section labeled something like "Behavioral Health" or "Mental Health" and see if outpatient out-of-network services are listed.
Call the Customer Service number on the back of your card. Ask specifically: Do I have out-of-network benefits for outpatient behavioral health services? If the answer is yes, follow up with:
Is there a separate out-of-network deductible?
What is my coinsurance or copay for out-of-network services?
Is there an annual cap on reimbursement?
How do I submit out-of-network claims?
Ask as many questions as you need until you fully understand what's covered, what isn't, and what you need to do to get reimbursed.
Ask your therapist for a superbill. This is an itemized receipt that includes the diagnosis code, procedure codes, and other information your insurer needs to process the claim. Most therapists who work with out-of-network clients provide these - I do - but it's worth confirming before you start.
A Note on Diagnosis and Privacy
One thing worth knowing before you go the out-of-network route: the same considerations around having a mental health diagnosis on file with your insurance company apply here. When you submit a superbill, your insurer receives your diagnosis code. For most people this isn't a concern, but if you're seeking therapy for personal growth rather than a clinical diagnosis, or if you have specific concerns about your insurance record, it's worth thinking through. I cover this in more detail in my post on using insurance for therapy.
How to Actually Submit Claims
Once you have your superbill, you'll submit it to your insurance company directly. How easy or painful that process is depends a lot on your insurer.
Some companies make it genuinely straightforward. Optum, for example, has a portal that's relatively clean and quick to use. The first time through might take ten minutes to set up and enter your information, but after that, submitting a month of claims usually takes just a few minutes. Reimbursement turnaround can also be faster with these companies - often within two weeks once you're set up.
Other insurers make it much harder. Confusing portals, paper forms, repeated requests for documentation, denials that require follow-up… Some companies seem to make out-of-network reimbursement deliberately cumbersome. If you're dealing with one of those, a service like Thrizer can be genuinely worth it.
If Your Insurance Makes It Difficult: Thrizer
Thrizer is a tool designed specifically to simplify out-of-network reimbursement for therapy clients. Rather than navigating your insurer's portal yourself, Thrizer handles the claim submission on your behalf and helps you track reimbursement status.
What makes Thrizer particularly useful is how it handles the financial side: instead of paying your therapist's full fee upfront and waiting weeks to be reimbursed, Thrizer can collect only your estimated out-of-pocket cost at the time of the session and handle the rest with your insurer directly. That takes a lot of the cash flow burden out of the equation. No more fronting the full fee and waiting on a check.
Thrizer isn't free, and if your insurer has an easy portal and you're comfortable submitting claims yourself, going direct may be simpler. But for anyone dealing with an insurer that makes reimbursement feel like a second job, it's a strong option worth knowing about.
When Out-of-Network Still Isn't Enough
If you've looked at your out-of-network benefits and they still don't make therapy financially workable, it's not the end of the road. Sliding scale options, platforms like Open Path Collective, and therapists who reserve reduced-fee spots are all worth exploring. I've got a full breakdown of affordable therapy options here.
And if you're still in the process of finding the right therapist, my guide to searching is here.