Understanding Your Insurance Benefits: What You Really Need to Know About Paying for Therapy

Let’s be honest—insurance is confusing. Most of us have a policy, but few of us fully understand what it covers or how it works. Sometimes it even feels like it’s meant to be confusing. And when it comes to mental health, that confusion can get in the way of finding the right care.

If you’ve ever wondered whether you really need to see someone who’s in-network with your insurance—or if working with an out-of-network provider like me might be a better fit—this guide is for you.

What Does “In-Network” Mean?

Seeing an in-network provider means your therapist has a direct agreement with your insurance company. They handle the billing, submit claims for you, and only charge you what your plan says you owe—whether that’s a copay or coinsurance.

Pros of In-Network Therapy:

• Typically lower out-of-pocket costs

• No need to submit claims yourself

• Easy to understand what you’ll pay once your deductible is met

Things to Keep in Mind:

• Limited availability: In-network therapists are in high demand. It might take time (and lots of emails or phone calls) to find someone with openings.

• Less privacy: Insurance companies can request your therapy records. Your therapist is required to provide them.

• Less control: Insurance may limit how often or how long you can be seen.

• Diagnosis required: Insurance won’t cover therapy without a diagnosis, which becomes part of your permanent medical record. This can potentially impact things like life insurance eligibility later on.

What About Out-of-Network Providers?

An out-of-network provider (like me!) doesn’t bill your insurance directly. Instead, they give you a detailed receipt (called a Superbill) that you submit to your insurance for possible reimbursement—if you have out-of-network benefits (usually with PPO plans).

There are companies out there that can make the process easier. One I frequently recommend is Thrizer. You simply create an account, upload your Superbill, and they handle the rest. For a small fee, Thrizer will submit the claim for you and deposit any reimbursement directly into your bank account—usually within a few weeks.

Pros of Out-of-Network Therapy:

• Often more privacy: Your therapist doesn’t work directly with your insurance, so there’s more protection around your personal info

• More provider options and shorter wait times

• May still receive reimbursement if you have OON coverage

Things to Keep in Mind:

• You pay the full fee upfront: Then wait for your insurance company to reimburse you, based on your plan.

• Diagnosis required: Insurance won’t reimburse for therapy without a mental health diagnosis.

• Some extra steps: You may need to submit claims or paperwork yourself—often online or through an app.

And Then There’s Self-Pay

Self-pay means you pay for therapy completely out of pocket and don’t use insurance at all.

Why Choose Self-Pay?

• Maximum privacy: Your sessions aren’t reported to insurance and don’t go on your medical record

(therapy notes can only be released with your written consent, a subpoena signed by a judge, or in rare situations where there is concern about your safety or the safety of others)

• No diagnosis required: You don’t have to meet criteria for a mental health disorder to access support

• Full control over your care: No limits on session length, frequency, or types of therapy

Who Chooses Self-Pay?

• People who want the highest level of privacy (first responders, military members, or others who worry about career impact)

• People without mental health coverage or with high deductibles

• Anyone looking for a specific provider or specialty

Things to Keep in Mind:

• Higher out-of-pocket cost: Since there’s no reimbursement, you’re responsible for the full session fee.

So…What’s Right for You?

Only you can decide which route makes the most sense—based on your budget, values, and care needs. The good news? You have options. And the more informed you are, the better you can advocate for the kind of support that works for you.

Got questions about how your benefits work or how to find a therapist who fits your needs? Reach out.

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.