Can I Use Insurance for a Therapist Who Isn’t In-Network? Here’s How It Works
Out-of-Network Therapy Benefits Explained in Chicago & Illinois
You Finally Found the Right Therapist… But They Don’t Take Your Insurance
You found a therapist who feels like they could be a good fit.
You read their page and thought:
“Finally… someone who gets it.”
And then you see it:
They don’t take your insurance.
Now you’re wondering:
Does that mean I can’t work with them?
How much would therapy actually cost?
Will my insurance pay for any of it?
What exactly is a superbill?
Do I have any other options?
If you're confused, you're definitely not the only one. Insurance can make an already personal decision feel unnecessarily complicated.
But here’s something many people don’t realize:
Depending on your insurance plan, you may still be able to use your benefits with a therapist who isn’t in-network.
If your plan includes out-of-network mental health benefits, you typically pay your therapist directly and may then receive partial reimbursement from your insurance company.
Let’s break down what that actually means, without all the insurance jargon.
What Does “Out-of-Network” Therapy Actually Mean?
When a therapist is in-network, they have a contract with your insurance company and have agreed to certain rates and billing requirements.
When a therapist is out-of-network, they don't have that contract with your insurance plan.
That's really what the term means.
Being out-of-network doesn't mean:
The therapist is less qualified
You can't work with them
Your insurance definitely won't help with the cost
You're out of options
It simply means that your insurance benefits may work differently.
Can I Use Insurance for an Out-of-Network Therapist?
Yes, depending on your insurance plan.
Some health insurance plans include out-of-network mental health benefits, which may reimburse you for part of the cost of seeing a therapist who isn't in your insurance network.
Typically, the process looks like this:
You choose an out-of-network therapist.
You pay the therapist's full session fee.
Your therapist provides you with a superbill.
You submit the superbill or claim to your insurance company.
Your insurance may reimburse you for a portion of the eligible cost, based on your specific benefits.
For some people, out-of-network benefits create more flexibility when the therapist they feel most comfortable with isn't available through their insurance network.
What Is a Superbill for Therapy?
The word “superbill” sounds much more complicated than it actually is.
A superbill is essentially a detailed receipt for your therapy services that contains information your insurance company may need to process an out-of-network claim.
It may include information such as:
Your therapist's name and credentials
Provider identification information
Dates of service
Type of service provided
Procedure or service codes
Session fees
A diagnosis code, when required
You can then submit the superbill to your insurance company according to its claims process.
Important: A superbill doesn't guarantee reimbursement. Your insurance company ultimately determines whether a service is covered and how much it will reimburse based on your individual plan.
How Much Will Insurance Reimburse for Out-of-Network Therapy?
This is usually everyone's biggest question:
“Okay, but how much will therapy actually cost me?”
Unfortunately, there isn't one answer that applies to every insurance plan.
Your reimbursement may depend on several things, including:
Whether your plan includes out-of-network mental health benefits
Your out-of-network deductible
How much of that deductible you've already met
Your out-of-network coinsurance
Your insurance company's allowed amount for the service
Whether the particular service is covered
For example, your plan might tell you that it covers 60% of out-of-network therapy after your deductible.
It can be tempting to assume that means insurance will pay 60% of whatever your therapist charges.
But that's not always how it works.
Your insurance company may calculate reimbursement based on its own allowed amount for the service rather than your therapist's full session fee.
Here's an example:
Imagine your therapist charges $180 for a session.
Your insurance company's allowed amount for that service is $150, and your plan reimburses 60% after your deductible has been met.
Your insurance might reimburse 60% of $150, or $90.
You would then be responsible for the remaining cost.
This is why it's helpful to ask your insurance company about both your reimbursement percentage and the allowed amount when checking your benefits.
What Is an Out-of-Network Deductible?
Here's another insurance term that causes a lot of confusion.
Your out-of-network deductible is the amount you may need to pay toward eligible out-of-network healthcare expenses before your insurance begins reimbursing you.
And here's the part people often don't realize:
Your in-network deductible and out-of-network deductible may be different.
That means even if you've already met your in-network deductible, you may still have a separate deductible for out-of-network services.
For example, if your plan has a $1,500 out-of-network deductible and you've only applied $300 toward it, you may need to pay additional eligible out-of-network expenses before reimbursement begins.
That's why checking your deductible is just as important as asking about your reimbursement percentage.
PPO vs. HMO: Can I See an Out-of-Network Therapist?
Your type of insurance plan can make a big difference.
PPO Plans
PPO plans often give you more flexibility to see healthcare providers outside of your network.
Depending on your specific plan, you may have:
In-network mental health benefits
Out-of-network mental health benefits
A separate out-of-network deductible
Coinsurance after your deductible is met
However, not every PPO plan includes out-of-network coverage, so don't assume you're covered just because “PPO” is written on your insurance card.
HMO Plans
HMO plans generally require you to receive non-emergency care from providers within the plan's network.
Out-of-network therapy is typically not covered unless your plan has a specific exception or authorization.
Your individual insurance policy, not simply whether you have a PPO or HMO, determines your actual coverage.
How Do I Check My Out-of-Network Therapy Benefits?
This is the part where many people get stuck.
You call insurance.
They start talking about deductibles, allowed amounts, coinsurance, claims, and percentages.
And five minutes later, you're somehow more confused than when you called.
So here's exactly what you can ask.
Call the member services number on the back of your insurance card and say:
“Hi, I'm considering seeing an out-of-network therapist and I'd like to check my outpatient mental health benefits.”
Then ask:
Do I have out-of-network benefits for outpatient mental health therapy?
What is my out-of-network deductible?
How much of that deductible have I already met?
What is my coinsurance after I meet my deductible?
Is reimbursement based on the therapist's actual fee or your plan's allowed amount?
What is the allowed amount for an outpatient psychotherapy session?
Do I need prior authorization?
How do I submit an out-of-network claim or superbill?
Is telehealth covered when I see an out-of-network therapist?
Are there any other requirements I should know about before starting therapy?
You don't have to become an insurance expert.
You just need enough information to understand what your plan may cover and what you may be responsible for paying.
Can I Use Out-of-Network Benefits for Online Therapy?
Possibly. Many insurance plans include telehealth mental health services, but coverage varies by plan.
If you're planning to see an out-of-network therapist virtually, ask your insurance company specifically whether your out-of-network mental health benefits apply to telehealth psychotherapy.
It's better to ask before your first appointment than to assume virtual and in-person services are handled the same way.
Why Do People Choose Out-of-Network Therapy?
Sometimes it's simply about having more choices.
You may consider an out-of-network therapist because:
You haven't found the right fit in-network
You may have searched your insurance directory, made calls, or even met with a few therapists and still haven't found someone who feels right.
You're looking for a particular specialty
Maybe you want someone who specifically works with anxiety, trauma, postpartum concerns, relationships, neurodivergence, identity, or another area that's important to you.
Culturally responsive or affirming care matters to you
For some clients, finding a therapist who understands the ways culture, race, gender, sexuality, family expectations, identity, or lived experiences affect mental health is especially important.
You want more options
Your insurance directory isn't necessarily the full universe of therapists available to you.
Using out-of-network benefits may allow you to expand your search.
Feeling safe, understood, and comfortable with your therapist can be an important part of building a strong therapeutic relationship.
Sometimes having more options makes it easier to find someone who feels like the right fit for you.
Is Out-of-Network Therapy Worth It?
There's no universal answer.
For some people, staying in-network makes the most financial sense.
For others, using out-of-network benefits may make it possible to work with a therapist they feel better matched with while still receiving some reimbursement from insurance.
Before deciding, it can help to consider:
Your therapist's session fee
Your deductible
Your expected reimbursement
How frequently you plan to attend therapy
What you can realistically afford
How important a particular therapist or specialty is to you
The goal isn't to choose the most expensive or least expensive option. It's to understand your choices so you can make the decision that works for you.
Out-of-Network Online Therapy in Chicago & Across Illinois
If you're looking for therapy in Chicago or elsewhere in Illinois, figuring out insurance and cost can sometimes feel like one more thing to manage when you're already overwhelmed.
You may be asking yourself:
Can I afford this?
Will my insurance cover it?
Am I going to get a surprise bill later?
Those are completely reasonable questions to ask before beginning therapy.
At Mindful Healing Counseling, we provide online therapy for clients throughout Illinois and believe you should have clear information about the financial side of therapy before you begin.
Not Sure What Your Insurance Actually Covers? We Can Help.
Insurance language can be confusing, even when you're staring directly at your benefits.
At Mindful Healing Counseling, we help make the process easier.
Depending on your situation and coverage, our team can:
Verify your insurance benefits
Help explain your expected costs
Discuss available in-network options
Explain self-pay options
Provide superbills for eligible out-of-network clients
Our goal is for you to have as much clarity as possible about the financial side of therapy before your first session, not after you receive an unexpected bill.
Keep in mind that benefit verification is an estimate based on the information provided by your insurance company and isn't a guarantee that your insurer will ultimately pay a claim.
Frequently Asked Questions About Out-of-Network Therapy
Can I use insurance for a therapist who is out-of-network?
Yes. If your health insurance plan includes out-of-network mental health benefits, you may be able to receive partial reimbursement for therapy with an out-of-network therapist. Your deductible, coinsurance, allowed amount, and other plan rules can affect how much your insurance reimburses.
How does out-of-network insurance work for therapy?
Typically, you pay your therapist’s full fee upfront. Your therapist may provide a superbill that you submit to your insurance company, and your insurer may reimburse you for part of the eligible cost based on your specific plan.
How much does insurance reimburse for out-of-network therapy?
The amount varies by insurance plan. Reimbursement may depend on your out-of-network deductible, coinsurance, your insurance company’s allowed amount for the service, and whether you’ve met your deductible.
What is a superbill for therapy?
A superbill is a detailed receipt from your therapist that includes information your insurance company may require to process an out-of-network claim. You submit it to your insurer to request reimbursement.
How do I submit a superbill to insurance for therapy?
Most insurance companies allow you to submit an out-of-network claim or superbill through their member portal, app, by mail, or through another designated claims process. Check your member portal or contact your insurance company for instructions specific to your plan.
Do PPO insurance plans cover out-of-network therapy?
Many PPO plans offer some coverage for out-of-network mental health services, but not all do. Check your specific benefits for your out-of-network deductible, coinsurance, allowed amount, and any requirements for mental health services.
What is an out-of-network deductible for therapy?
An out-of-network deductible is the amount you may need to pay toward eligible out-of-network healthcare services before your insurance begins paying its share. Your out-of-network deductible may be separate from your in-network deductible.
Can I use out-of-network benefits for online therapy or telehealth?
Some insurance plans cover out-of-network telehealth therapy, but coverage varies. Ask your insurance company whether your out-of-network mental health benefits apply specifically to virtual psychotherapy sessions.
Does a superbill guarantee that my insurance will reimburse me?
No. A superbill provides the documentation needed to submit an out-of-network claim, but it does not guarantee reimbursement. Your insurance company determines coverage and payment according to your individual plan.
Do I need a mental health diagnosis for insurance to reimburse therapy?
Insurance companies may require a mental health diagnosis and other clinical information for therapy to qualify for reimbursement. Requirements vary by insurance plan, so check with your insurer if you have questions about what is required.
Can I use my insurance if my therapist doesn’t accept insurance?
Possibly. If your therapist doesn’t bill your insurance directly but your plan includes out-of-network mental health benefits, you may be able to pay your therapist directly, submit a superbill or claim, and receive partial reimbursement from your insurance company.
How do I know if I have out-of-network mental health benefits?
Check your insurance member portal or call the member services number on the back of your insurance card. Ask specifically whether your plan includes out-of-network outpatient mental health benefits, what your deductible and coinsurance are, and how reimbursement is calculated.
You Still Have Options
Finding a therapist you connect with and then discovering they're out-of-network can be disappointing.
But it doesn't necessarily mean you can't work with them.
Understanding your out-of-network benefits can help you figure out:
What your insurance may cover.
What you may pay.
And whether working with that therapist makes sense for you.
You don't have to figure everything out at once.
Ready to Find a Therapist Who Feels Like the Right Fit?
Mindful Healing Counseling provides warm, affirming, trauma-informed online therapy for adults, teens, couples, and families throughout Chicago and Illinois.
We accept select insurance plans, and depending on your coverage, we can also provide superbills for out-of-network reimbursement.
Not sure which option applies to you? That's okay. We'll help you understand your options before you get started.
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