How to Use Your Out-of-Network Benefits for Mental Health Therapy
If you’ve found a therapist you love, but they’re not in-network with your insurance, don’t panic—you may still be able to get reimbursed for a portion of your sessions using your out-of-network (OON) benefits.
Out-of-network benefits can feel confusing at first, but we’re here to break it down into simple steps so you can feel more confident navigating the process.
First... What Are Out-of-Network Benefits?
When a therapist isn’t contracted with your insurance company, they’re considered “out of network.” Some insurance plans will still help pay for part of the cost when you see an out-of-network provider—usually after you meet a deductible.
Think of it like this: you pay your therapist directly, and then your insurance may pay you back for a portion of the cost.
Step 1: Call Your Insurance Company
Grab your insurance card and call the customer service number on the back. Ask these specific questions:
Do I have out-of-network benefits for mental health or behavioral health?
What is my deductible and how much of it have I met?
What percentage of the session fee will be reimbursed after I meet my deductible? (You will want to know the reimbursement rates for codes 90791 (intake code) and 90837 (standard session code).
Is there a limit to the number of sessions per year?
Do I need pre-authorization?
Do I need a superbill or claim form?
How do I submit my superbill or claim form?
How do I track progress of my superbill or claim form?
Tip: Write down the answers! It’s easy to forget who said what.
Step 2: Pay Your Therapist and Get a Superbill
Your therapist will likely provide you with a superbill, which is just a fancy word for a detailed receipt. It usually includes:
Your therapist’s name, credentials, and tax ID
The date and type of session
The fee you paid
A diagnosis code (required for reimbursement)
You’ll need this to submit your claim. At Mind Made Well Counseling, our system sends these automatically to each of our out-of-network clients after they pay for each session. You can also find them in your client portal.
Step 3: Submit a Claim to Your Insurance
Most insurance companies allow you to upload claims online through your member portal. Others may require you to mail or fax a claim form along with the superbill.
Check with your insurance provider about their preferred method.
Step 4: Get Reimbursed
Once your claim is processed, your insurance company will send you a check (or deposit funds to your bank account) for the eligible amount—usually a percentage of what they consider a “reasonable and customary fee.”
For example:
If your therapist charges $160/session (as we do) and your insurance reimburses 70% after you meet your deductible, you could get around $112 per session back.
Bonus Tips:
Use an app: Services like Reimbursify can help automate claims filing.
Track everything: Keep copies of your superbills, claim confirmations, and insurance communications.
Ask your therapist for help: Many therapists are used to working with OON clients and can help guide you. We are happy to help as best we can!
Final Thoughts
Using out-of-network benefits can be a little extra work—but it often pays off, literally. And when it comes to your mental health, finding the right therapist is worth the effort.
If you're unsure where to start or just want someone to walk you through it, don’t hesitate to reach out to use at Rachel@mindmadewell.com. We’re always happy to help you make sense of it all.