Understanding Out-of-Network Insurance Benefits

Empowering you to make the most of your benefits and understand your options for paying for therapy.

Using Out-of-Network Insurance Benefits

If I’m not in your insurance network, many clients are still able to receive partial reimbursement for therapy through their out-of-network (OON) benefits.

Here is a simple guide to help you understand how this process works and how to check your coverage.

  • You can usually find the Member Services or Behavioral Health number on the back of your insurance card. When you call, let them know you’d like to verify your out-of-network mental health benefits for outpatient psychotherapy.

    Here are some helpful questions to ask:

    ✻ Do I have out-of-network benefits for outpatient mental health therapy?

    ✻ What percentage of the session fee will be reimbursed

    ✻ What is my out-of-network deductible, and how much of it have I met this year?

    ✻ How do I submit claims for reimbursement (online portal, fax, or mail)?

    ✻ Do I need preauthorization or a referral from my primary care provider?

    ✻ Is there a limit to the number of sessions covered per year?

    ✻ What documentation do you need to process reimbursement? (They’ll usually say a superbill)

    💡Tip: Write down the date of your call, the name of the representative, and a reference number for your records.

  • A superbill is an itemized receipt that includes all the details your insurance company needs to process your claim. You’ll receive these automatically through your secure client portal - either after each session or monthly, depending on your preference.

    Each superbill includes:

    ✻ Your name and date of birth

    ✻ Date and length of session

    ✻ CPT code (e.g., 90837 - Individual Therapy, 60 min)

    ✻ Diagnosis code (required by insurance for reimbursement)

    ✻ My credentials, license number, and NPI

    ✻ The fee charged and amount paid

    Most insurance providers allow you to submit superbills directly through their member portal or mobile apps.

  • Deductible: The amount you pay out of pocket before your insurance starts reimbursing you.

    Coinsurance: The percentage you pay after your deductible is met (e.g., you pay 30%, insurance pays 70%).

    Allowed Amount: The maximum fee your insurance company considers “reasonable” - reimbursement is based on this amount, not necessarily the full session fee.

    Out-of-Pocket Maximum: Once you reach this total yearly amount, insurance covers 100% of eligible services.

  • ✻ You’ll pay for each session at the time of service.

    ✻ I’ll provide your superbill so you can submit it to your insurance.

    ✻ Your insurance company will review your claim and, if approved, reimburse you directly.

    ✻ Reimbursement is typically received within 2-6 weeks, depending on your insurer

Disclaimer: This information is provided for educational purposes and client convenience only. While I’m happy to provide superbills and general guidance, I cannot guarantee that you will receive reimbursement from your insurance company. Coverage, reimbursement amounts, and eligibility vary by plan and provider. Please contact your company directly to confirm your benefits and reimbursement options.

The most meaningful investments are often the ones that strengthen how we live, not just what we own.

Using HSA & FSA Cards for Therapy

What are HSA & FSA cards?

HSA (Health Savings Account): A personal account you or your employer fund to pay for qualified medical expenses with pre-tax dollars

FSA (Flexible Spending Account): A similar employer-sponsored account that lets you set aside pre-tax income for health-related costs within a plan year.

Both can typically be used to pay for mental health services, including psychotherapy, when provided by a licensed clinician.

Why use an HSA or FSA card for therapy?

You can pay for sessions tax-free, reducing your overall health-care costs.

It’s often simpler than reimbursement - funds are drawn directly from your account at the time of payment.

Many clients use these cards to budget for ongoing self-care or therapy goals throughout the year.

  • Before using your card:
    Call the number on the back of your HSA/FSA card or check your plan’s online portal.

    Ask:

    ✻ Are outpatient psychotherapy sessions with a licensed psychologist covered as an eligible medical expense?"

    ✻ Do I need to submit documentation, such as an invoice or superbill?

    ✻ Are there spending limits or categories for mental health services?

    💡Tip: Keep any written confirmation or emails from your HSA/FSA provider for your records.

  • ✻ You can use your HSA/FSA card just like a debit card when paying for your session.

    ✻ If your provider declines the charge (some cards restrict by merchant type), simply pay with another card and request a receipt to submit manually for reimbursement.

    ✻ Your superbill can also serve as documentation if your HSA/FSA administrator requests proof of service.

  • Some plans may ask for documentation showing:

    ✻ The date and type of service (e.g., psychotherapy, 50 min session)

    ✻ The provider’s name, credentials, and license number

    ✻ The amount paid

    All of this information is already included on your superbill or session receipt.

Disclaimer: This information is provided for educational purposes and client convenience only. While therapy is generally an eligible expense under most HSA and FSA plans, coverage requirements vary. I cannot guarantee that your plan will approve every charge or reimbursement request. Please verify your specific account rules with your HSA/FSA administrator or employer before using your funds.