Out-of-Network Benefits & Options
If we don't participate with your specific insurance plan, you may still have options to receive partial reimbursement through out-of-network benefits.
First: Verify Network Status
Before assuming you're out-of-network, please check our accepted plans and call your insurance to verify.
Understanding Out-of-Network Benefits
How partial reimbursement works when seeing a non-participating provider
Many insurance plans include out-of-network (OON) benefits, which means they'll reimburse a portion of your costs even when you see a provider who isn't contracted with your plan.
How Out-of-Network Coverage Typically Works:
- You pay the full session fee upfront to your provider at the time of service.
- We provide a superbill—a detailed receipt with all codes and information your insurance needs.
- You submit the superbill to your insurance company (online, by mail, or fax).
- Your insurance processes the claim and sends reimbursement directly to you.
Not All Plans Have OON Benefits
Some plan types—particularly HMOs and certain EPOs—have no out-of-network coverage at all. PPO plans are most likely to have out-of-network benefits.
Key Terms for Out-of-Network Coverage
Understanding these terms helps you estimate your costs
Out-of-Network Deductible
The amount you must pay out-of-pocket before your plan starts reimbursing OON claims.
Coinsurance
The percentage your plan pays after you meet your deductible.
Usual & Customary Rate (UCR)
The amount your insurance considers "reasonable" for a service in your area.
Balance Billing
The difference between what you paid and what insurance reimburses.
Questions to Ask Your Insurance
Call the member services number on your card to ask:
- "Do I have out-of-network mental health benefits?"
- "What is my out-of-network deductible?"
- "What percentage do you reimburse for out-of-network mental health services?"
- "How do I submit a superbill for reimbursement?"
Frequently Asked Questions
Common questions about out-of-network benefits
Ready to Schedule?
Whether you're using in-network benefits, out-of-network reimbursement, or self-pay, we're here to help.