How to Use Your Out-of-Network Insurance Benefits for Therapy

You’re open to paying for therapy sessions up front and getting reimbursed through your insurance plan—but you’re not even sure how that works or what your policy covers. The good news is that many clients successfully use their out-of-network benefits to help cover therapy costs. Below is a simple, step-by-step guide to help you figure out what your insurance will reimburse and how to make the most of your policy.

Step 1: Grab Some Paper (or your Notes app) & Your Insurance Card

Make sure you have a way to jot down the answers—this will help you clearly communicate with your therapist and follow up with your insurance if needed.

Flip your card over and call the member services number (usually a 1-800 number listed on the back). You’ll be speaking with a representative who can walk you through your out-of-network mental health benefits.

Step 2: Have This List of Questions Handy

Date and time of call:

Ask the representative the following questions and take notes as you go:

Here is your revised and renumbered list with the two new items added at the beginning:

1. Name of the representative you spoke with:

2. Call tracking number or representative ID:

3. Do I have out-of-network mental or behavioral health coverage?

• If yes, continue with the rest of the questions.

• If no, you’ll likely need to either pay out-of-pocket without reimbursement or find an in-network provider.

4. Do I need a referral to see an out-of-network therapist?

5. What is my deductible for out-of-network services, and has it been met?

• This is the amount you must pay out-of-pocket before reimbursement begins.

6. How many therapy sessions are covered per calendar year?

7. What is the “allowed amount” or coverage per session?

• This is the amount your insurance company considers reasonable for a therapy session, which they base reimbursement on.

8. What is the reimbursement rate for the following CPT codes?

• 90791 (Initial intake session)

• 90834 (38–52 minute therapy session)

• 90837 (53+ minute therapy session)

9. Is telehealth covered, and if so, what modifier or service code is needed?

10. How do I submit claims?

• Some companies require a paper form, while others offer online submission or a mobile app.

11. What is the typical processing time for claims? When should I expect to receive reimbursement?

Understanding your benefits can help you plan ahead and ease the financial stress of therapy. Once you’ve gathered this information, you’ll have a clearer picture of how much therapy might cost you after insurance reimbursement—and how to make the process as smooth as possible.

Find this list helpful? Click here to download a printable checklist you can use during your call.

DISCLAIMER:

The information provided on this page is intended for general informational purposes only and is not intended to serve as legal, financial, or insurance advice. While we aim to offer helpful guidance on how to navigate out-of-network benefits and insurance reimbursement for mental health therapy, individual plans vary widely. Please consult directly with your insurance provider to understand the specific terms, coverage, and requirements of your policy. This content does not create any contractual relationship and should not be considered a guarantee of reimbursement or coverage.