While I don’t accept insurance directly, many clients are surprised to learn their plan still covers a meaningful portion of session costs through out-of-network (OON) benefits.

Here’s what that means and how to find out what your plan offers.

What “Out-of-Network” Means:

When a provider is “out-of-network,” it means I don’t have a direct contract with your insurance company. You pay the full session fee yourself, and your insurance company may reimburse you for a portion of that cost — the amount depends on your specific plan.

How Reimbursement Works:

1.  You pay the full session fee at the time of your appointment.

2.  I provide you with a superbill: an itemized receipt with everything your insurer needs (diagnosis code, session dates, fee, and my license information).

3.  You submit the superbill to your insurance company. Alternatively, I can submit superbills on your behalf automatically using the benefits tool, Thrizer.

4.  Your insurance company reimburses you directly, typically 50–80% of the session fee, once your out-of-network deductible is met.

Questions to Ask Your Insurance Company:

Call the member services number on the back of your insurance card and ask:

•     Do I have out-of-network benefits for outpatient mental health therapy? (CPT code: 90834)

•     What is my out-of-network deductible, and how much have I already met this year?

•     Once my deductible is met, what percentage of the session fee is reimbursed?

•     Is there a limit on the number of sessions covered per year?

•     Do I need a referral or pre-authorization for outpatient therapy?

•     How do I submit a claim, and how long does reimbursement usually take?

Making This Easier.

You don’t have to manage this on your own. I use Thrizer to make the process simpler:

•     I can check your specific OON benefits before your first session, so there are no surprises. You can also use my OON benefit calculator using this link.

•     I can submit claims automatically on your behalf through Thrizer— no paperwork required.

•     I’m also happy to walk through this with you on our consultation call.

Questions about how this works for your plan? I’m happy to help you figure it out before you commit to anything. Reach out on my contact form to schedule a consultation call.