Navigating Out-of-Network Insurance for Psychotherapy: What You Need to Know

If you’re considering therapy but are unsure about how your insurance can help cover the costs, you're not alone. Many people find themselves in this situation, especially when a therapist is considered "out-of-network" (OON) by their insurance plan. But here’s the good news: many insurance providers still offer reimbursement for out-of-network services, which can significantly reduce your out-of-pocket expenses.

In this post, I’ll break down what "out-of-network" means, which insurances typically accept OON payments, common questions about using out-of-network benefits for psychotherapy, and provide resources to help you get the most out of your benefits.

What is Out-of-Network Insurance?

When a therapist is "in-network," it means they have a contract with your insurance company to offer services at a discounted rate. However, when a therapist is "out-of-network," they do not have this contract, and you may need to pay the full cost upfront. But, depending on your insurance plan, you can often still receive partial reimbursement for these services.

Which Insurances Typically Accept OON Payments?

Based on common industry practices, several major insurance companies tend to offer out-of-network benefits for psychotherapy. While policies can vary, the following providers are known for offering OON reimbursement:

• Aetna

• Cigna

• United Healthcare

• Blue Cross Blue Shield

• Oxford Health Plans

These companies generally provide out-of-network benefits, but the percentage reimbursed can vary depending on your specific plan.

Common Questions About Using Out-of-Network Benefits for Psychotherapy

1. How Do I Know If I Have Out-of-Network Benefits?

The best way to find out if your insurance offers out-of-network benefits is to contact your insurance provider directly. Ask them:

• "Do I have out-of-network mental health benefits?"

• "What is my deductible for out-of-network services?"

• "What percentage of the service cost will be reimbursed?"

• "What is the process for submitting claims?"

2. Will I Have to Pay Upfront for Services?

Yes, in most cases when you use out-of-network benefits, you will need to pay the therapist’s full fee upfront. Afterward, you can submit a claim to your insurance company for reimbursement.

3. How Much Will I Be Reimbursed?

Reimbursement rates for out-of-network services can range anywhere from 50% to 80%, depending on your insurance plan and whether you’ve met your deductible. Be sure to ask your provider about the specific rate applicable to your policy.

4. What Information Do I Need to Submit a Claim?

To submit a claim for reimbursement, you will typically need:

• A receipt or invoice from your therapist, also known as a “superbill.”

• Your insurance policy information.

• A completed claim form from your insurance company.

5. What Is a Superbill?

A superbill is a detailed invoice your therapist provides that contains all the necessary information your insurance company needs to process your reimbursement. It typically includes:

• The therapist's name, credentials, and license information.

• A breakdown of services provided.

• Diagnosis codes.

• Dates of service and session fees.

If you have any more questions about out-of-network insurance or want to book a consultation, feel free to contact me at angieyemma@thedanceoftherapy.com or schedule a 15-minute consultation through my Calendly.

Don't let confusion about insurance stop you from getting the support you need. Many clients successfully use their out-of-network benefits to make therapy more affordable. Let’s work together to find the best path forward for you!