Understanding Out of Network Benefits: How Your Insurance Plan Can Still Cover Therapy Sessions

Finding a therapist who accepts your insurance can feel confusing, especially when you hear the term "out of network." Many people assume that out of network means their insurance will not cover therapy sessions at all. That is not always true. Understanding how out of network benefits work can save you money and open up more options for care. This post explains what out of network means, why many licensed therapists are out of network, and how you can find a therapist who fits your insurance plan.

What Does Out of Network Mean?

When a therapist is out of network, it means they do not have a contract with your insurance company. This does not mean your insurance will not cover your sessions. Instead, your insurance may cover a portion of the cost, but usually at a different rate than in-network providers.

Insurance companies negotiate rates with in-network therapists, often paying less than the therapist’s usual fee. Some therapists choose to stay out of network because insurance companies sometimes pay closer to their private rates when they are not contracted. This allows therapists to charge fees that better reflect their experience and the quality of care they provide.

Why Many Licensed Therapists Are Out of Network

Licensed therapists often prefer to stay out of network for several reasons:

• Better reimbursement rates: Insurance companies may pay closer to the therapist’s private rate when they are out of network.

• Less paperwork: Being out of network means therapists handle fewer insurance claims and administrative tasks.

• More control over fees: Therapists can set their own fees without being limited by insurance contracts.

• Flexibility in treatment: Therapists may have more freedom to offer personalized care without insurance restrictions.

  
  

Because of these reasons, many fully licensed therapists choose to remain out of network, even though they accept insurance through out of network benefits.

How to Check Your Out of Network Benefits

Before booking a session with an out of network therapist, it is important to understand your insurance plan’s out of network benefits. Here’s what to do:

• Call your insurance company or check your online member portal.

• Ask about your out of network coverage for mental health or therapy services.

• Find out if you have a deductible that must be met before insurance starts paying.

• Ask about the percentage of reimbursement you can expect after the deductible.

• Confirm if you need to submit claims yourself or if the therapist can submit claims on your behalf.

  
  

Knowing these details helps you avoid surprises and plan your therapy budget.

Confirm the Therapist’s License and Credentials

Not all providers qualify for out of network benefits. Many insurance plans require that the therapist be fully licensed in the state where you live. You can verify a therapist’s license by checking the state’s counseling licensing board website.

Be aware that:

• Residents in counseling or licensed residents in counseling usually do not qualify for out of network benefits.

• Only therapists with a full license (such as Licensed Professional Counselor, Licensed Clinical Social Worker, or Licensed Marriage and Family Therapist) typically meet insurance requirements.

  
  

Always ask the therapist about their license status and verify it independently to ensure your insurance will cover the sessions.

Ask If the Therapist Can Submit Claims for You

Some out of network therapists will submit claims to your insurance company for you. This can make the process easier and faster. If the therapist does not submit claims, you will need to:

• Pay the therapist directly at the time of service.

• Submit the claim yourself to your insurance company.

• Wait for reimbursement based on your out of network benefits.

  
  

For example, if you pay $200 per session, your insurance should reimburse you close to that amount after you meet your deductible. Keep detailed receipts and explanation of benefits (EOB) documents for your records.

Practical Tips for Finding a Therapist Who Takes Your Insurance

• Start with your insurance provider’s directory: Look for therapists listed as out of network providers who accept your plan.

• Call therapists directly: Ask about their insurance policies, license status, and claim submission process.

• Check online reviews and credentials: Verify licenses and read patient feedback.

• Understand your financial responsibility: Know your deductible, copay, and reimbursement rates.

• Consider teletherapy options: Some therapists offer virtual sessions that may be covered under your plan.

  
  

Summary

Out of network does not mean your insurance will not cover therapy sessions. Many licensed therapists choose to stay out of network because insurance companies often pay closer to their private rates. To make the most of your out of network benefits, check your insurance plan’s coverage, confirm the therapist’s license, and ask if they submit claims for you. This knowledge helps you find the right therapist while managing your costs effectively.