Out-of-network” sounds like it means “not covered” – but for most PPO-style insurance plans, it just means the billing process works differently. If your insurance is out-of-network with your therapist, you’re not out of options. Here’s exactly how it works, step by step, what a superbill actually is, and what you’ll likely end up paying.
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When a therapist or practice is out-of-network with your insurance plan, it means they don’t have a direct contract with your specific insurer. That’s different from “not accepting your insurance” – many plans, especially PPO plans, still include an out-of-network benefit that reimburses you for a portion of the cost, even when the provider isn’t contracted with your insurer directly.
The important exception: HMO plans frequently don’t include any out-of-network benefit at all. If you have an HMO, it’s worth confirming this specifically before assuming you’ll get any reimbursement.
Mind in Motion is currently out-of-network with EmblemHealth, BlueCross BlueShield, 1199SEIU, Beacon Health Options, and ComPsych. See our full out-of-network page here for details on each.
How Out-of-Network Billing Works
The process is more straightforward than it sounds:
- You pay your session fee at the time of service. This is typically $125–$350, depending on the therapist.
- You receive a superbill. This is an itemized receipt containing everything your insurer needs to process a reimbursement claim (more on this below).
- The claim gets submitted. Depending on the practice and your specific plan, either you submit the superbill yourself, or the practice submits it on your behalf.
- Your insurer reimburses you directly, based on your plan’s out-of-network benefit percentage – once any applicable deductible has been met.
That’s it. The main functional difference from in-network care is when you find out your final cost – with in-network care, you know upfront; with out-of-network care, you find out after reimbursement is processed.
What's a Superbill?
A superbill is the document that makes out-of-network reimbursement possible. It typically includes:
- Your diagnosis code (an ICD-10 code assigned by your therapist)
- The procedure code (a CPT code – for example, 90837 for a 53+ minute individual therapy session)
- The date of service
- Your provider’s National Provider Identifier (NPI) number
- The fee charged for the session
Your insurer uses this information to determine what portion of the fee falls under your out-of-network mental health benefit. A good practice will generate this for you automatically – you shouldn’t have to build it yourself.
What You'll Likely Pay
This is the part everyone actually wants to know, and the honest answer is: it depends entirely on your specific plan. That said, a few patterns hold fairly consistently:
- Most clients using out-of-network benefits end up paying between 0% and 20% of the total session cost out of pocket, once reimbursement is complete.
- If your plan has an out-of-network deductible, you’ll be responsible for the full session fee until that deductible is met, after that, your reimbursement percentage typically kicks in.
- Self-pay session rates generally range from $125–$350, depending on the therapist, and this is the number your reimbursement percentage is calculated against.
This is common with HMO plans. If that’s the case, you’re not out of options – many practices, including ours, offer sliding-scale rates based on income as an alternative.