Using Your Out-Of-Network (OON) Benefits: A Guide for Clients
Navigating insurance for therapy can feel so confusing and overwhelming, especially if you’re considering seeing a therapist who is out-of-network. At Ocean View Therapy, I want to make this process as clear and stress-free as possible, so you can focus on your mental health without worrying about paperwork or coverage.
Put simply, 1. You pay upfront for your session. 2. You submit a Superbill to your insurance. 3. You get reimbursed by your insurance.
Let’s break this down together..
What Are Out-of-Network Benefits?
Many insurance plans, particularly PPOs, offer out-of-network benefits. This means that even if a therapist is not in your insurance network, your plan may still cover a portion of the cost of therapy. Coverage amounts, co-pays, and deductible requirements vary by plan, so it’s important to check with your insurance provider.
What Is a Superbill?
A Superbill is an itemized receipt of the services you receive from an out-of-network therapist. It includes information such as:
- Date and length of each session
- CPT (billing) codes
- Diagnosis code (if applicable)
- Provider information
You can submit the Superbill to your insurance company for reimbursement according to your plan’s out-of-network policy. This process is sometimes called self-submission or out-of-network reimbursement. Thrizer or Reimbursify can help with this for a small fee. (I streamline the process for my clients using Thrizer so they can focus on their care, not the admin.)
How to Check If You Have Out-of-Network Benefits
1. Review your insurance plan documents: Look for sections labeled "Out-of-Network Services," "Reimbursement," or "Mental Health Coverage."
2. Call your insurance company: Ask specifically if your plan covers out-of-network mental health benefits for virtual psychotherapy and what percentage of the session cost is reimbursable. (Reimbursement rates can vary.)
3. Ask about deductibles and limits: Some plans have separate out-of-network deductibles or session limits.
Tips for Maximizing Your Benefits
- Keep all Superbills and receipts for easy submission.
- Submit claims promptly according to your insurer’s timeline. (Again, Reimbursify or Thrizer can hep with this for a small fee.)
- Track your reimbursement and follow up with your insurance company if needed.
How I Can Help
At Ocean View Therapy, I provide Superbills for all out-of-network clients and can answer questions about the process. While I cannot guarantee reimbursement, I’m happy to guide you through the process.
For clients using Out-of-Network (OON) benefits, I use Thrizer to help check OON benefits and estimate reimbursement to make the process easier. Clients also have the option of submitting claims for a small fee through Reimbursify. Both options can streamline the reimbursement process and reduce the administrative burden on clients.
If you’re unsure whether you have OON benefits, many PPO plans offer partial reimbursement for therapy, so it may be worth checking before scheduling. I’m happy to help you navigate the process or answer questions as you explore what works best for you.
Navigating insurance doesn’t have to be overwhelming. With a little guidance, you can make your therapy sessions more accessible and ensure you’re using your benefits to support your mental health. If you have any more questions about this, please feel free to reach out.
Please Note: The information provided on this website is for educational and informational purposes only. It is not intended to be mental health therapy, diagnosis, treatment, or a substitute for professional therapeutic services. Viewing this site or communicating through it does not establish a therapist–client relationship.
If you are seeking mental health services, please contact a licensed professional in your area or reach out directly to inquire about starting therapy. If you are in crisis, call your local emergency services or crisis hotline immediately.
