Out-of-Network Mental Health Insurance: How to Get Reimbursed for Therapy

Navigating insurance for mental health therapy can feel overwhelming, especially if your provider is out-of-network.

This step-by-step guide will help you understand your benefits and submit claims for reimbursement, so you can focus on your mental health and well-being.

Step 1: Gather Your Basic Information

Before calling your insurance company, have these essentials ready:

your insurance card
policyholder’s date of birth
the cost of your therapy session

Step 2: Call Your Insurance Provider

Dial the Member Services number on your insurance card. Ask specifically for “Out-of-Network Mental Health Coverage” or “Behavioral Health Benefits.”

Confirm your plan offers reimbursement for out-of-network therapy.

Step 3: Ask Key Questions About Coverage

Ask your insurance representative about:

1) Do I have out-of-network benefits for therapy?

2) What percentage of the session fee is reimbursed?

3) What is the allowed amount?

4) How much of my deductible has been met?

5) What is the claim submission process (mail, online portal, or app)?

6) Do I need a claim form or superbill?

7) How long after the session can I file for reimbursement?

8) How long does it take to receive reimbursement?

Tip: Say: “Hi, I want to use my out-of-network benefits for outpatient mental health therapy. Can you explain my coverage and tell me exactly what I need to submit for reimbursement?”

Step 4: Request a Superbill from Your Therapist

A superbill is a detailed receipt including provider information, CPT codes, diagnosis codes, and session fee. Most insurers require this for reimbursement.

Step 5: Submit Your Claim

Fill out your insurance claim form (if required), attach the superbill or itemized receipt, and submit via mail, fax, or online portal as directed by your insurance company.

Step 6: Track Your Claim and Follow Up

Record the call reference number, note the claim submission date, and follow up if reimbursement hasn’t been received within the stated timeframe.

Why Understanding Coverage Matters

Understanding your out-of-network mental health benefits can save you money and make therapy more accessible. Follow this guide to confidently submit claims and reduce out-of-pocket costs.