How to Use Out-of-Network Benefits for Therapy
Navigating insurance coverage for therapy can feel overwhelming. What does my insurance cover? How do I find a therapist in-network? What are my out of pocket costs? This can be especially tricky when working with a therapy provider who is Out-of-Network.
But the good news is: if you have out-of-network benefits, you can still use your insurance! You can still get reimbursed for a portion of your therapy costs when working with an out-of-network therapy provider. Here’s a straightforward guide on how to use those benefits—and how to submit claims using superbills.
What Are Out-of-Network Benefits?
Out-of-network benefits are part of many PPO (Preferred Provider Organization) and POS (Point of Service) insurance plans. They allow you to see a therapist who is not in your insurance company’s network and still get reimbursed for part of the cost. This gives you the flexibility to choose a therapist who best meets your needs—even if they don’t work directly with your insurance provider.
Step 1: Verify Your Out-of-Network Coverage
Before you begin therapy, it’s a good idea to call the number on the back of your insurance card and ask:
Do I have out-of-network benefits for mental health services?
What percentage of the session cost will be reimbursed?
Is there a deductible I need to meet first?
Are there limits on how many sessions are covered?
What information do I need to include when submitting a claim?
This will give you an idea of your Out-of-Network benefits. Make sure to write down the answers for your reference.
We also allow our clients to get an estimate of your Out-of-Network benefits by using a handy tool called Mentaya. The website allows you to input your insurance information, choose the therapist you are interested in working with, and get an estimate of what your Out-of-Network reimbursement will be.
To try it out click the link: https://mentaya.co/checkbenefits/rpl4UDJbIopxNJhQEHp7
Step 2: Pay for Sessions and Collect Superbills
When you work with an out-of-network therapist, you’ll typically pay for sessions upfront. Afterward, you’ll receive a superbill, which is a detailed receipt that includes all the information your insurance company needs to process a claim.
Since we use SimplePractice at Calm Mind Therapy, you’ll have access to monthly superbills through the secure client portal. Here’s how to download them:
Log into the SimplePractice client portal.
Go to the “Billing” or “Documents” section.
Find and download the superbill for the dates of service you want to submit.
Each superbill includes:
The therapist’s name, license, and NPI number
Service dates and CPT codes
Your diagnosis code (if one was given)
The fee charged and the amount paid
Step 3: Submit the Superbill to Your Insurance Company
To file a claim, follow your insurance company’s submission process. This typically involves:
Filling out a claim form (available on their website)
Attaching your superbill(s)
Mailing, faxing, or uploading the documents to your insurance portal
Make sure to keep a copy of everything for your records. Claims can take a few weeks to process, and your insurance company may follow up with additional questions.
While working with out-of-network benefits does take a little more effort, many clients find it well worth it for the ability to choose the right provider. Out-of-Network options allow you to take advantage of your insurance benefits and invest in your mental health with confidence.
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Calm Mind Therapy is a boutique mental health practice located in Ardmore, PA, specializing in the care of children, adolescents, and adults. Our mission is to provide the Main Line with high-quality mental health services for all ages. Our goal is to help our clients achieve emotional well-being and build a life worth living. Serving clients in Ardmore, Bryn Mawr, Wynnewood, Narberth, Radnor, Lower Merion, Haverford, Havertown, Villanova, Swarthmore, Devon, Berwyn, Malvern, Bala Cynwyd, and more.
