How to Find Out if Your Health Insurance Covers Out-of-Network Psychotherapy

Accessing therapy shouldn’t feel out of reach just because your provider isn’t in-network with your insurance. In fact, many people are surprised to learn that they have out-of-network mental health benefits that can significantly offset the cost of therapy.

If you're considering working with a therapist who is out-of-network (like me), here’s a step-by-step guide to help you find out what kind of coverage your insurance offers- plus, a list of the most helpful questions to ask when you call.

What Are Out-of-Network Benefits?

When a therapist is out-of-network with your insurance company, it means they don’t bill your insurance directly. Instead, you pay the therapist up front, and your insurance company may reimburse you for a portion of the cost- if your plan includes out-of-network coverage for mental health care.

Step-by-Step Guide to Checking Your Benefits

Step 1: Gather Your Insurance Info

Before you call, have your insurance card nearby. You’ll need your member ID number, the insurance provider’s phone number (usually on the back of the card), and possibly your group number.

Step 2: Call the Customer Service Number

Call the number listed for member services or behavioral health. Let them know you’d like to check your out-of-network mental health benefits.

Step 3: Ask These Questions

You can read these questions aloud or jot down the answers as you go. It’s okay to ask them to slow down, repeat things, or email you the details!

Questions to Ask Your Insurance Provider:

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

• Is there a deductible I need to meet first? If so, how much is it, and how much of it have I already met?

• After meeting my deductible, what percentage of the session fee is reimbursed?

• Is there a maximum number of therapy sessions covered per year?

• Are telehealth or online therapy sessions covered?

• Do I need a referral or pre-authorization to use out-of-network services?

• Are these CPT codes covered?
  • 90791 (Initial Evaluation)
  • 90837 (60-minute therapy session)

• How do I submit claims for reimbursement? What documentation is required?

Step 4: Reach Out to Your Therapist

Once you know your benefits, you can decide whether using out-of-network coverage feels doable for you. I’m happy to provide a superbill- a detailed receipt you submit to your insurance provider for reimbursement.

A Note on Accessibility

I also believe that mental health care should be accessible and equitable. That’s why I reserve a limited number of sliding scale spots for clients who aren’t able to pay my full fee. If finances are a concern, I encourage you to reach out and ask about current availability.

Final Thoughts

Navigating insurance can be confusing, but you don’t have to do it alone. Many of my clients are surprised by how much support their insurance plans offer, even out-of-network.

If you have questions about payment, sliding scale, or using your benefits, don’t hesitate to reach out. I'm here to help.

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