Cost & Access

Get Reimbursed For Out-Of-Network Therapy

Kim Davis Clinically reviewed by Dr. Chris Peterson, Clinical Reviewer May 28, 2026 (Updated Jul 16, 2026) 3 min read · Fact-checked & reviewed

Get Reimbursed For Out-Of-Network Therapy

In this article

You found the right therapist. She specializes in exactly what you’re dealing with, her reviews are solid, and she has an opening next week. Then you check her insurance status: out-of-network. Most people close the tab.

That’s a mistake.

Out-of-network therapy reimbursement is real, it’s dramatically underused, and for most people it cuts the actual cost by half or more. You’ll still pay upfront. But you’re getting money back.

What “Out-of-Network” Actually Means (and What It Doesn’t)

Plan Type	Out-of-Network Mental Health Coverage	Typical Reimbursement	Prior Authorization Required
PPO	Yes	50-80% of allowable amount	Varies by plan
POS	Sometimes	50-80% of allowable amount	Varies by plan
HMO	No (except emergencies)	Not applicable	Not applicable

Insurance companies have contracts with certain providers. Those are in-network. Everyone else is out-of-network. When you see an out-of-network therapist, you pay the full fee at the session, then submit a claim to your insurer for partial reimbursement.

The key word is partial. You won’t recover 100%. But depending on your plan, you might get back 50% to 80% of what’s called the “allowable amount,” which is whatever rate your insurer considers reasonable for that service in your area.

This isn’t a loophole. It’s a standard benefit on most PPO and some POS plans. HMO plans almost never cover out-of-network care except emergencies. If you have an HMO, check your documents before you get excited.

Here’s the thing that actually matters: the therapists you most want to see, specialists in trauma, eating disorders, OCD, EMDR, are disproportionately out-of-network. And usually by choice. In-network reimbursement rates are so low that accepting insurance becomes economically irrational. Add in the administrative work of dealing with insurance companies, and the best clinicians frequently just opt out of panels entirely. That’s infuriating if you’re trying to find someone. But it’s also why the out-of-network benefit exists in the first place.

The First Call You Need to Make

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Before your first appointment, call the member services number on the back of your insurance card. Ask these questions. Write down the answers, the rep’s name, and the call reference number.

Does my plan include out-of-network mental health benefits?
What is my out-of-network deductible, and how much have I met this year?
After the deductible, what percentage does the plan reimburse?
What is the allowable amount for CPT code 90837? (That’s the code for a standard 53-minute therapy session.)
Is there an annual or lifetime maximum on out-of-network mental health benefits?
Do I need prior authorization before starting treatment?
How do I submit a claim, and what documentation do I need?

CPT codes matter because they’re how insurance defines different types of service. 90837 is the standard code for individual therapy. 90834 covers 38 to 52 minutes. 90847 is family therapy. Knowing which code your therapist bills lets you verify your exact reimbursement rate before you commit to anything.

How the Math Actually Works

Your therapist charges $200 per session. Your plan’s allowable amount for 90837 is $130. Your out-of-network deductible is $500, and you haven’t met any of it yet. After the deductible, the plan reimburses at 60%.

For the first few sessions, everything goes toward your deductible. Once you’ve paid $500 out-of-pocket, the insurer kicks in. After that, for each $200 session, you pay $200, the insurer reimburses you 60% of $130 (that’s $78), and your actual cost per session drops to $122.

That’s not free. But it’s meaningfully different from $200.

The gap between what your therapist charges and what the insurer considers “allowable” is called the balance, and you’re stuck with it regardless. If your therapist charges $250 and the allowable is $130, the insurer calculates reimbursement off $130, not $250. That balance? You pay it. This is the part that surprises almost everyone.

Superbills: The Document That Makes This Possible

Your therapist won’t file your insurance directly. You do. And to do that, you need a superbill.

A superbill is an itemized receipt that includes: the provider’s name, credentials, and NPI number (the unique provider identifier); the practice address; your diagnosis code (ICD-10); the CPT code for each session; the date of service; and the fee charged. Ask for one monthly or after each session, depending on how often you want to file.

Most out-of-network therapists are familiar with superbills and will provide them without pushback. If yours doesn’t know what one is, that’s worth noticing.

Submit the superbill to your insurer along with a claim form (you can download it from your insurer’s website or patient portal). Keep copies of everything. Processing usually takes two to six weeks. If a claim gets denied, the denial letter will say why, and you have the right to appeal. A surprising number of denials are just administrative errors that get fixed on appeal.

Using a Reimbursement Service or FSA/HSA

If the filing process sounds exhausting, you have options.

Services like Reimbursify and Nirvana automate out-of-network claim submission for a fee or a percentage of your reimbursement. Worth considering if you’re seeing multiple providers or if you know yourself well enough to admit you won’t do the paperwork. An unclaimed $78 reimbursement is worth nothing.

Separately: if you have a Flexible Spending Account or Health Savings Account, use pre-tax dollars to pay your therapy sessions upfront. That alone gets you a discount equal to your marginal tax rate, typically 22% to 32% for middle-income earners, before any insurance reimbursement even arrives. Combining FSA/HSA payments with reimbursement can make out-of-network therapy financially reasonable even on a modest income.

Finding the Right Therapist to Start With

If you’re still searching, Psychology Today’s therapist directory lets you filter by insurance, specialty, and sliding scale availability. Many out-of-network therapists offer reduced fees for uninsured clients or those paying entirely out-of-pocket. Worth asking directly.

One consistent thing I’ve noticed: people think asking about fees is awkward or rude. It isn’t. Private practice therapists handle this conversation daily. A straightforward “I’m going to be filing out-of-network claims, can you provide monthly superbills?” is completely normal.

If you’re in crisis and cost is the barrier, don’t wait on paperwork. The 988 Suicide and Crisis Lifeline is free, confidential, and available 24/7 by call or text.

The insurance system wasn’t designed to make this easy. But “not easy” and “not worth it” aren’t the same thing. Make the call, get the superbill, submit the claim. A therapist who’s a strong clinical fit is worth the paperwork.

This article is for general informational purposes only and does not constitute mental health, medical, or clinical advice. If you are in crisis or experiencing a mental health emergency, please contact the 988 Suicide and Crisis Lifeline (call or text 988) or go to your nearest emergency room. Always consult a licensed mental health professional for care specific to your needs.

Sources

Disclosure: As an Amazon Associate, we earn a small commission from qualifying purchases at no extra cost to you. We only recommend products that genuinely support the topics covered in this article.

Feeling Good: The New Mood Therapy (~$14), The most clinically studied self-help book for depression, recommended by therapists worldwide as CBT-based self-treatment.
Depression & Anxiety Therapy Journal (~$10), 8-week guided journal with trigger tracking and mood diary, mirrors the homework your therapist would assign between sessions.

Recommended Resources

Disclosure: As an Amazon Associate, we earn a small commission from qualifying purchases at no extra cost to you. We only recommend products that genuinely support the topics covered in this article.

Feeling Good: The New Mood Therapy (~$14), The most clinically studied self-help book for depression, recommended by therapists worldwide as CBT-based self-treatment.
Depression & Anxiety Therapy Journal (~$10), 8-week guided journal with trigger tracking and mood diary, mirrors the homework your therapist would assign between sessions.

Note: This site provides general mental health information only and is not a substitute for professional mental health care. If you are in crisis, please contact the 988 Suicide & Crisis Lifeline by calling or texting 988.

Frequently Asked Questions

Can my therapist bill my insurance directly if they're out-of-network?

Sometimes, yes. This is called 'single-case agreements,' where an insurer grants an out-of-network provider temporary in-network status for a specific patient, usually when there's no in-network provider with the required specialty nearby. They're not common and require initiative from both you and your therapist, but they're worth asking your insurer about if your situation warrants it.

What if my claim is denied?

Request the denial reason in writing. Common reasons include missing information, wrong CPT code, or a service classified as not medically necessary. Each of these is appealable. Write a formal appeal letter, include the superbill, any clinical notes your therapist is willing to provide, and cite the specific plan language that supports your claim. First-level appeals succeed more often than people expect.

Does out-of-network coverage apply to telehealth therapy?

Generally yes, though this varies by plan and state. Telehealth parity laws in many states require insurers to cover telehealth at the same rate as in-person visits. Call your insurer to confirm, and make sure your therapist uses the correct telehealth-specific modifier on the superbill (usually modifier 95 or GT).

What's the difference between an out-of-network deductible and my regular deductible?

Most plans have two separate deductibles: in-network and out-of-network. The out-of-network deductible is almost always higher. You have to meet it before reimbursement starts. Some plans apply out-of-network spending toward your out-of-pocket maximum; others don't. This is one of the most confusing parts of the process, so get it clarified on that first call.

Should I use an out-of-network therapist if I can barely afford the copay for an in-network one?

Probably not, unless you're very confident about the reimbursement math and have cash flow to bridge the gap between paying sessions and receiving reimbursement checks. In-network care at a manageable cost beats out-of-network care that creates financial stress. That said, sliding scale rates from out-of-network therapists sometimes end up cheaper than in-network copays. Compare actual numbers before deciding.

Authoritative Sources & Further Reading

This guide draws on data and guidance from independent, authoritative organizations:

National Institute of Mental Health Mental-health research
SAMHSA Treatment and support services
American Psychological Association Psychology resources
988 Suicide & Crisis Lifeline 24/7 crisis support

Kim Davis Wellness Educator

Kim Davis is a certified mindfulness instructor who teaches evidence-based stress reduction techniques and helps people build self-care practices that support their mental health between therapy sessions. She approaches wellness with practicality and without toxic positivity, focusing on skills that are genuinely useful when life is hard. At Therapy Finder Guide, she covers mindfulness practices, coping strategies, and the self-care approaches that complement professional mental health support.

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