Starting therapy is a big step, and finding a therapist who truly fits your needs matters just as much as the decision itself. But many people run into the same snag along the way, “the therapist they connect with doesn’t accept their insurance”.
This is what out of network therapy usually means. It is worth considering but knowing how the process works and how much value comes back to you is important.
You may wonder how much you’ll need to pay or how much your co-pay will be, or whether the paperwork is even worth the effort in the first place.
The good news is that out of network care is often more manageable than it first appears once you understand how the pieces fit together.
What Is Out of Network Therapy?
Out-of-network therapy simply means working with a therapist who doesn’t have a contract with your health insurance company. Because there’s no agreement between them and your insurer, the therapist sets their own fee, and you pay for each session yourself at the time of your appointment.
Many plans, especially PPO and POS plans, include out-of-network benefits, which means you can pay for your sessions and then have your insurer reimburse you for part of the cost afterward. In other words, the coverage doesn’t disappear; it just works a little differently, with the money coming back to you rather than going straight to your therapist.
After your session, your therapist gives you a superbill. You submit that superbill to your insurance company, and if your plan includes “out of network benefits” they may reimburse you for part of what you paid.
For example: your therapist charges $150 for a session. You pay that amount upfront. Your insurer’s “allowed amount” for that service is $120, and your plan reimburses 70% of it once you’ve met your out of network deductible. In that case, you’d receive about $84 back, bringing your real cost down to roughly $66 per session.
Out of Network vs. In-Network Therapy Billing: What’s the Difference?
There are several important differences between in-network and out-of-network therapy billing, from how much you pay to how claims are processed and what your insurance plan covers. The table below breaks down exactly how the two compare.
| In-Network Therapy | Out of Network Therapy | |
| Contract with insurer | Yes, therapist agrees to a set rate | No, therapist sets their own fee |
| Who you pay | Typical copay of around $20–$60 per session depending on your plan | The therapist’s full fee upfront, typically $135 to $250+ |
| Who bills insurance | Your therapist bills the insurer directly | You submit a superbill to your insurer yourself |
| How coverage works | Insurer pays the therapist the agreed rate | Insurer reimburses you a percentage of the “allowed amount” |
| When the deductible applies | In-network deductible, often lower | Separate out of network deductible, often higher |
| Typical reimbursement | None | Commonly 60–80% of the allowed amount, after the deductible (per insurers like Aetna) |
| When money comes back | Not applicable | Weeks after you submit the claim |
| Paperwork and follow-up | Minimal handled for you | You manage claim submission and follow-up |
| Best suited to | Lower upfront cost and simplicity | More choice of therapist, with reimbursement offsetting cost |
Out of Network Therapy Cost and the Reimbursement Process
As for out of network therapy, your therapist can typically charge between $135 and $250+ per session upfront.
However, the whole payment is not considered eligible for out of network therapy reimbursement. Your insurer will decide how much of that payment will be reimbursed to you.
How is Reimbursement Calculated?
Once you submit your claim, your insurance company reviews it against your plan. It checks whether the therapy service qualifies for coverage, whether your deductible has been met, and what percentage of the eligible cost your plan will reimburse. The insurer then calculates what it will pay.
In practice, most out-of-network plans reimburse somewhere between 50% and 70% of that allowed amount once your deductible is met, and some PPO plans go as high as 80%. The difference stays your responsibility, which is why the money you get back rarely matches a clean percentage of what you actually paid.
There also isn’t one fixed timeline for every insurer. The claim has to be processed, the plan’s benefits applied, and an Explanation of Benefits (EOB) issued before the final reimbursement is determined.
The EOB is useful because it shows what the therapist charged, what the insurer considered the allowed amount, what was covered, and what remains your responsibility. If the payment doesn’t arrive when expected, checking the claim status with the insurer is usually the easiest way to find out where things stand.
How Is Out of Network Therapy Billing Done?
Out of network therapy billing may seem complicated at first, but once you understand how claims, reimbursements, and patient payments fit together, the process becomes much easier to navigate.
Step 1: Check Your Out of Network Benefits First
Before your first session, it helps to call your insurance company and confirm what your plan actually offers. A few questions make the picture clear:
- Do I have out of network benefits for outpatient mental health?
- What is my out of network deductible, and how much of it have I met?
- What percentage will you reimburse once it’s met?
- Is there a limit on how many sessions are covered?
Step 2: Pay for Your Session Upfront
This is the part that feels different from in-network care. You’ll be covering the entire cost before any reimbursement comes back to you. You can arrange bills per session or on the entire treatment plan.
Step 3: Receive Your Superbill
Your therapist provides a superbill for your sessions. It is built specifically for insurance reimbursement, so it carries the clinical and billing details your insurer needs to process a claim.
A plain receipt lacks these details and codes, and they’re exactly what allow your insurer to recognize the service as reimbursable. Many therapists provide the superbill monthly, though some offer it per session.
Step 4: Submit Your Claim
With your superbill in hand, you send it to your insurer. Most major insurers now let you upload claims through their online member portal, which tends to be the quickest route, though mail is usually an option too. It’s a good habit to note the date you submitted and keep a copy of everything, which makes following up simple if anything is missing. Filing deadlines vary from one plan to the next, so it’s worth confirming your insurer’s window and submitting well within it.
Step 5: Receive Your Explanation of Benefits and Reimbursement
After your insurer reviews the claim, they send the EOB. If the claim is approved, your reimbursement follows by check or direct deposit. Processing times vary by insurer, but if a few weeks pass with no word, a quick call to member services is worth making. When the EOB arrives, check to confirm the reimbursement matches what you expected based on your plan’s coverage.
NOTE: Submit your superbills regularly rather than letting them pile up. Doing so helps you meet your deductible sooner, keeps you comfortably within your plan’s filing deadline.
What is a Superbill?
If a therapist is out of network, the session usually isn’t billed directly to the insurance company in the same way an in-network visit is. Instead, the therapist gives you a superbill.
It is a detailed record of the care you paid for that can be used to request out of network therapy reimbursement from your insurer.
It generally includes:
- Therapist information: Name, professional credentials, license information, and National Provider Identifier (NPI).
- Practice information: The practice’s Tax ID and other provider details required by the insurer.
- Dates of service: The date or dates on which therapy was provided.
- CPT codes: Codes identifying the type of psychotherapy service provided. CPT codes are used to identify healthcare procedures and services for claim submission.
- Diagnosis code: The applicable ICD-10-CM diagnosis code associated with the service. CMS explains that healthcare services are matched with diagnosis codes when submitted for reimbursement.
The exact information required can vary by insurer, so it is worth checking the plan’s out of network claim instructions before submitting anything.
Can a Superbill Get Denied?
A superbill can be accurate and still result in no reimbursement. Sometimes the issue is the paperwork; other times, it is the insurance plan itself.
Common problems include no out of network benefits, missing information, coding errors, deductible not met, service not covered, or filing deadline missed.
A denial isn’t necessarily the end of the process. If a claim is denied, the insurer must explain the reason, and eligible claims can generally be appealed through the plan’s internal appeals process.
Benefits of Out of Network Therapy?
When insurance limits the list of therapists available, it can make finding the right person more difficult. Out of network therapy gives you the option to look beyond that list and consider a therapist based on their experience, approach, and the type of support you need.
Here are some more benefits:
Choose Your Own Therapist
In-network, your options are shaped by who’s on your plan and who has openings, which can mean settling for availability over fit. Out-of-network, the choice is yours, and you can find someone whose specialty and style genuinely match what you’re going through, which matters more than almost anything else in therapy.
Get Tailored, Specialized Care
In-network coverage can point people toward more standardized treatment. Choosing out-of-network makes it easier to find a therapist with deep experience in exactly what you need, whether that’s trauma, grief, relationships, or anxiety. Instead of adapting yourself to the available care, you find care built around you.
Working with Targeted/Focused Modalities
Insurance often comes with strings attached, including session limits, required diagnoses, and pre-authorizations that influence how long you can stay in therapy. Out-of-network care removes those constraints, so you and your therapist decide together how often to meet and when you’re truly ready to finish.
Greater Privacy
For some people, keeping therapy separate from insurance is important. Paying privately can reduce the need to involve an insurance company in the treatment process, which may feel more comfortable when discussing deeply personal experiences.
Fewer Scheduling Limitations
Finding an in-network therapist with an opening isn’t always easy. Looking beyond the network gives you more providers to consider, which can make it easier to find someone whose availability fits your schedule.
Does Growth Thru Change Provide Out of Network (OON) Therapy?
Yes. At Growth Thru Change, we offer both in-network and out of network (OON) support.
Many of our private-pay clinicians bring advanced training, years of experience, and a deeper clinical focus in areas such as trauma, relationships, grief, identity work, and mood disorders. Several are also trained in specialized approaches like EMDR, Internal Family Systems (IFS), DBT, Ketamine-Assisted Psychotherapy (KAP) and psychodynamic therapy.
Working out of network gives clinicians the room to offer the time, focus, and tailored approach that more complex or long-standing challenges often need.
If you’re considering private-pay therapy with us, we’re glad to help you understand how it works, including how to check your out of network benefits and what reimbursement might look like for your plan. That way, you can make the choice that feels right for both your care and your budget.
Frequently Asked Questions
Does insurance still pay anything if I see an out-of-network therapist?
Yes, your insurance may reimburse part of an out-of-network therapy cost if your plan includes out-of-network benefits. After you pay the therapist, you submit a superbill, and your insurer reimburses the eligible portion, usually 50-70%, according to your deductible and plan terms.
Is my insurance plan even the type that covers out-of-network care?
It depends on your specific plan. PPO and POS plans commonly include out-of-network benefits, while HMO plans typically do not cover out-of-network therapy except in limited circumstances, such as emergencies. Confirm your benefits directly with your insurer before starting care.
Why does out-of-network therapy cost more out of pocket than in-network care?
Out-of-network therapy may cost more upfront because it gives you greater freedom than in-network care to choose a therapist based on specialty, experience, therapeutic approach, availability, and personal fit. You may also have access to more specialized treatment, greater scheduling flexibility, fewer insurance-driven limitations, and more privacy.
What is a superbill, and what does it include?
A superbill is a detailed record of your therapy services that you submit to your insurer for potential reimbursement. It generally includes therapist and practice information, dates of service, CPT procedure codes, and the applicable ICD-10-CM diagnosis code.
How do I file a claim for out-of-network reimbursement?
After paying for your session, obtain a superbill from your therapist and submit it to your insurance company, usually through its online member portal or by mail. Keep copies of your documents and confirm your plan’s filing deadline before submitting.
What happens if my superbill or claim gets denied?
A claim may be denied because your plan lacks out-of-network benefits, information is missing, coding is incorrect, your deductible hasn’t been met, the service isn’t covered, or the filing deadline was missed. Your insurer should provide the reason, and eligible claims can generally be appealed.
Will I get a written estimate of costs before I start?
Your actual out-of-pocket cost depends on your therapist’s fee, deductible, allowed amount, reimbursement percentage, and plan benefits. Before beginning, you can confirm these details with your insurer and ask the therapist about their session fee so you understand the expected costs.
Which insurance plans does Growth Thru Change work with?
Growth Thru Change provides both in-network and out-of-network therapy options. Our therapists work with Aetna and Independence Blue Cross, with Medicare enrollment in progress, and also offer private-pay options. Depending on your plan, you may be able to receive in-network coverage or use out-of-network benefits for eligible therapy services.
What exactly are “out-of-network benefits”?
Out of network benefits are partial coverage or reimbursement by your insurance company for therapy and other similar services. Depending on your plan, out-of-network benefits may cover outpatient mental health services, such as Individual psychotherapy, Couples or family therapy, Mental health evaluations and assessments, Psychiatric or medication management, behavioral health services, Partial reimbursement after the out-of-network deductible is met, Out of network out-of-pocket maximum, etc. However, coverage varies by insurance plan.
