A Quick Guide to Using Out‑of‑Network Mental Health Benefits

Out‑of‑network (OON) mental health care is common. Many therapists don’t contract with insurance because it allows more flexibility and individualized care. As a result, lots of patients pay upfront and then request reimbursement from their insurance plan.

Step 1: Research Your OON Benefits, Call the number on your insurance card and ask:

• “Do I have out‑of‑network mental health benefits?”

• “What is my OON deductible, copay, or co-insurance and what percentage is reimbursed after I meet it?”

• “Where do I submit claims for reimbursement?”

Step 2: Gather the Documents You’ll Need, Your therapist typically provides:

• Superbill (itemized receipt)

• CPT code

• ICD‑10 diagnosis code

• NPI number

• Date of service & fee

• Proof of payment

Step 3: Submit Your Claim, Most insurers follow a similar process. Claims are usually processed within 10–30 days.

• Log into your member portal

• Find Submit a Claim

• Upload your superbill + proof of payment

• Enter session details (date of service, provider NPI)

• Submit and save your confirmation

  
  

Step 4: Receive Reimbursement

Your Explanation of Benefits (EOB) will show:

• The plan’s allowed amount

• What applied to your deductible

• Your reimbursement amount

Tips to Maximize Reimbursement

• Submit claims monthly

• Ensure all codes are included

• Keep copies of everything

• Appeal denials—many are reversed

Please stop in our office or call if you are a client and have any questions.