How to Use Your Out-of-Network Benefits for Therapy (Without Losing Your Mind)
So you’ve found a therapist who gets it—someone you actually want to open up to. There’s just one problem: they’re out-of-network with your insurance. Cue the headache.
Here’s the good news: If you have out-of-network (OON) benefits, you can still get reimbursed for a portion of your therapy costs. You just need to know how to navigate the system (without wanting to scream into the void).
Let’s break it down, step-by-step:
1. Check if You Have Out-of-Network Benefits
Start by calling your insurance company (or checking your benefits portal) and ask:
Do I have out-of-network mental health benefits?
What is my deductible for out-of-network services?
What percentage of the session fee is reimbursed after I meet the deductible?
Is there a limit to the number of sessions covered per year?
Do I need a referral or pre-authorization?
Pro tip: Write it all down. Insurance reps aren’t always consistent, so having notes can help if you need to appeal anything later.
2. Understand What You'll Pay Upfront
When you see an out-of-network therapist, you’ll typically pay the full session fee at the time of service. After that, you can submit a claim to your insurance company for partial reimbursement—if you’ve met your OON deductible.
Here’s a quick example:
Your therapist charges $150/session.
Your plan reimburses 70% of “eligible” charges after you meet a $500 deductible.
You submit your receipts, and once you hit that $500 mark, you may start getting ~$105 per session back.
3. Ask Your Therapist for a Superbill
To file for reimbursement, you’ll need a superbill—a detailed receipt that includes:
Your name and diagnosis code (insurance requires this, unfortunately)
The therapist’s information and license number
Date, length, and cost of the session
CPT code (the code for the type of service—e.g., 90837 for a 53+ minute individual session)
Most therapists who are out-of-network are used to this process and can provide a superbill monthly or upon request.
4. Submit the Claim to Your Insurance
Every insurance company is a little different, but typically you’ll either:
Upload the superbill through your insurance portal
Submit it by mail with a claims form (often downloadable from their site)
After processing, you’ll receive reimbursement by check or direct deposit.
5. Use Tools That Make It Easier
If this sounds like too much admin, you’re not alone. Here are a few tools that can make things easier:
Reimbursify or Thrizer: These apps help you file claims directly and track reimbursement
Zaya Health (for therapists): Some providers partner with platforms like this to file claims on your behalf
A Few Things to Keep in Mind
Reimbursement rates vary—some plans reimburse a percentage of your therapist’s rate, while others use a “customary rate,” which is usually lower.
You’ll need a diagnosis—this is required by insurance for reimbursement. If you’re not comfortable with that, private pay may be a better option.
It can take time—reimbursements usually take 2–6 weeks.
Final Thoughts
Using your out-of-network benefits is possible—it just takes a little upfront effort and a good system. If working with someone who really sees you is a priority (and let’s be honest, it should be), this route can offer more freedom in choosing the right therapist without being boxed in by networks.
And if you’re working with Rooted Therapy Houston, we’re happy to walk you through the process or provide the documentation you need to make it as painless as possible.
Ready to get started?
Let’s schedule a free 15-minute consultation to talk about what therapy could look like for you.
This blog is for informational purposes only and is not a substitute for professional or financial advice.