Out-of-network benefits explained
Your insurance may cover more of this than you think.
Out-of-network therapy benefits are one of the most underused features of most PPO plans — and the process that usually stops people is the paperwork. That part is handled here.
What OON means
01What out-of-network benefits actually mean.
Most insurance plans have two tiers of providers: in-network (therapists who have contracted with your insurer at discounted rates) and out-of-network (therapists who have not). Many people assume out-of-network means not covered. For PPO plans, that is almost never true. If you have a PPO, you almost certainly have out-of-network benefits — meaning your insurer will reimburse you for a portion of what you pay an out-of-network provider.
How reimbursement works
02How reimbursement works.
You pay the session fee at the time of service. I generate a superbill — a detailed receipt containing the clinical codes your insurer needs. I submit that superbill directly to your insurance company on your behalf. Your insurer processes the claim and sends reimbursement to you, typically within two to four weeks. Many clients with PPO plans recover 60–80% of session fees once their deductible is met.
What makes this practice different
03What makes this practice different.
Most out-of-network providers give you the superbill and leave the filing to you. Here, I handle the submission directly — and for clients who prefer a faster claims dashboard, I also use Reimbursify, a third-party service that automates the back-and-forth with your insurer. All you need to do is provide your insurance information at intake. The rest is taken care of.
How to check your benefits
How to check your out-of-network benefits before the first session.
Call the member services number on the back of your insurance card and ask these questions:
- 01
Do I have out-of-network mental health benefits?
- 02
What is my out-of-network deductible, and how much of it have I met?
- 03
What percentage of the allowed amount does my plan reimburse for out-of-network outpatient mental health?
- 04
Is there a limit on the number of sessions covered per year?
You can also ask these questions during the free 15-minute initial call — if you have your insurance card available, we can often look it up together.
Why OON often means better care
Why out-of-network care often means better care.
In-network providers accept reimbursement rates set by insurers — rates that have not kept pace with the cost of quality clinical care. Out-of-network providers set their own fees, which allows them to maintain smaller, more focused caseloads and provide the depth of attention that complex clinical situations require. When your situation is genuinely complex — trauma, high-conflict divorce, coercive control, addiction, forensic involvement — you need a clinician with the time and training to meet that complexity. OON care makes that possible.
Questions about your specific plan?
Reach out before scheduling. If you have your insurance card, we can often clarify your benefits during the free 15-minute initial call.