Out-of-Network Insurance Benefits FAQs

Using OON benefits allows you to choose a provider who best fits your needs rather than being limited to in-network options. In-network providers are often required to follow insurance-mandated guidelines, which can dictate aspects of your care, such as the need for a formal mental health diagnosis, the types of therapy approaches covered, the length and frequency of sessions, and even when therapy should end. Insurance companies may require ongoing treatment plans and progress notes to approve continued coverage, which can limit the flexibility of treatment and compromise your privacy.

With an OON provider, you have full control over your care without insurance-imposed restrictions. You don’t need a diagnosis to receive treatment, making therapy accessible for personal growth, relationships, or life transitions. Your therapist can use the best approaches for you without insurance dictating what’s "medically necessary," and you decide the frequency and duration of sessions—free from third-party interference.

Using out-of-network benefits means that your insurance plan allows you to see providers who are not contracted with your insurance company. Instead of your provider billing the insurance directly, you pay for sessions upfront and then submit a claim for reimbursement.

You can check your insurance policy details online, call the customer service number on the back of your insurance card, or review your Summary of Benefits and Coverage (SBC) document. Look for terms like “out-of-network mental health benefits” or “reimbursement for non-preferred providers.”

A superbill is a detailed invoice that includes the necessary information for insurance reimbursement, such as diagnosis codes, session details, and provider information. After receiving a superbill from your therapist, you submit it to your insurance company for processing.

Reimbursement rates vary by plan. Typically, insurance covers a percentage of the session cost after you meet your out-of-network deductible. This percentage could range from 50% to 80%, but it depends on your plan’s terms.

After receiving a superbill from your therapist, you will submit it along with a claim form to your insurance company. This can often be done through your insurance provider’s website, by mail, or via a claims submission app.

Yes, most Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) allow you to use funds for therapy. You can pay for sessions with your HSA/FSA card or submit a reimbursement request.

Yes, most insurance plans count OON payments toward your out-of-network deductible, which can help you reach reimbursement eligibility sooner.