How to Use Your Out-of-Network Benefits for Therapy (and Why You Might Want To)

If you’ve ever been told a therapist is “out-of-network” with your insurance, it can sound like code for expensive and complicated. Many people think it means your insurance won’t pay a dime—or that you’ll be stuck doing mountains of paperwork for nothing.

The truth? If you have a PPO plan or certain other insurance plans, you probably do have out-of-network (OON) benefits. And yes, you can absolutely use them for therapy—even if your therapist doesn’t “take” your insurance directly.

In fact, using OON benefits can sometimes mean you get the therapist you actually want to see and get reimbursed for a big chunk of the cost. Here’s how it works.

First: What “Out-of-Network” Really Means

Your insurance plan has a list of providers who’ve signed contracts to accept your insurance’s payment rates—those are “in-network” providers. Anyone not on that list is considered “out-of-network.”

Here’s the part many people don’t realize: Being out-of-network doesn’t mean your insurance won’t pay anything. It just means they may pay you back after you’ve paid your therapist directly, rather than paying the therapist up front.

If you’ve got OON benefits, you might get reimbursed for 50%… 60%… even up to 80% of the cost, depending on your plan. That can make a big difference—especially over the course of months of therapy.

Why You’d Want to Use Your OON Benefits

Here are a few reasons people choose to go this route:

• You can pick the therapist who’s the best fit for you. The right therapeutic relationship is one of the biggest predictors of progress in therapy. If your ideal therapist isn’t in-network, OON benefits give you a way to still work with them.

• More privacy. When you use insurance in-network, your therapist often has to submit a diagnosis and details about your treatment. With self-pay + OON reimbursement, you decide what information gets shared.

• Specialized expertise. Therapists with niche expertise—whether that’s ADHD in adults, couples therapy, or something else—are often out-of-network. OON benefits make it easier to work with specialists who may not be tied to insurance panels.

• Faster access. In-network therapists often have long waitlists. OON therapists may have more availability, so you can start sooner.

It’s Easier to Submit OON Claims Than You Think

In the old days, filing for reimbursement could be a headache: paper forms, snail mail, phone calls to confirm they received it. Thankfully, most insurance companies now have online portals or apps where you can upload your paperwork in a few clicks.

Even better: Many therapists (myself included) can provide you with a superbill—a simple receipt with all the information your insurance company needs. You just upload it to your insurer’s website, and they process your claim.

There are also apps and services—like Reimbursify or Mentaya—that will submit claims for you for a small fee, often with just a photo of your superbill.

How Much Could You Get Back?

This depends on your plan’s out-of-network rates. Here’s a quick example:

• Let’s say your therapist’s rate is $150 per session.

• Your plan reimburses 70% for OON mental health services after you meet your deductible.

• If your deductible is already met, you could get back $105 per session. That makes your actual cost $45 per session.

The percentage you get reimbursed might range from 50% to 80%—the higher your plan’s OON coverage, the more you save.

How to Use Your OON Benefits for Therapy: Step-by-Step

1. Call your insurance company. Ask:

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

• What’s my deductible for out-of-network services, and how much of it have I met?

• After the deductible, what percentage of the session cost will you reimburse?

• Is there a maximum you’ll pay per session (an “allowed amount”)?

• How do I submit claims, and how long does reimbursement take?

2. Book with your therapist. You’ll pay their full fee up front.

3. Get a superbill. Your therapist will give you a document with the right codes, dates, and details for your claim.

4. Submit the claim. Upload your superbill to your insurance company’s online portal or app, or send it by mail if they require it.

5. Get reimbursed. The insurance company sends you a check or deposits the reimbursement directly into your account.

What to Expect in Real Life

Using OON benefits usually works best if:

• You can pay the full session fee up front while waiting for reimbursement.

• You understand your plan’s deductible—because you may not get reimbursed until it’s met.

• You keep receipts and submit claims regularly.

If you’ve never tried it before, it might feel intimidating. But after the first claim, you’ll see it’s usually just a matter of repeating the same steps.

Using Out of Network Benefits may be easier than you think.

A Quick Note on Privacy

One reason some people prefer self-pay and OON reimbursement is privacy. Insurance companies often require a diagnosis to approve payment, and in-network providers typically have to share ongoing treatment notes or updates.

When you self-pay and submit OON claims, your therapist gives only the minimal required info—usually a diagnosis code and the dates of service—nothing about what was actually discussed in your sessions.

The Bottom Line

If you’ve been avoiding therapy because the therapist you want isn’t “covered” by your insurance, it’s worth checking your out-of-network benefits. You might find it’s not only possible—it’s surprisingly straightforward.

With a little up-front work to understand your plan and a few minutes each month to submit claims, you could get a big portion of your costs reimbursed. That opens the door to working with the therapist who’s the right fit for you, without giving up the possibility of saving money.

And when it comes to your mental health, having the right therapist in your corner can be worth far more than the paperwork it takes to get there.

Ready to see if VineStone is the right fit for you?

I offer a free, 15-minute consultation so we can talk through your needs, answer your questions, and help you decide if we’re a good match. Schedule your consultation today and take the first step toward the care you deserve.