Understanding Out-of-Network Benefits for Therapy

Finding a therapist who feels like the right fit for you is important. Sometimes that person isn’t in your insurance network, and that’s where out-of-network benefits come in. These benefits can help you access the care you need—but it’s important to know how they work and how to verify them.

What Are Out-of-Network Benefits?

Out-of-network benefits let you see a therapist who isn’t part of your insurance plan’s network. Your insurance may cover part of the cost, even if the provider isn’t in-network. This gives you more freedom to choose a therapist who aligns with your values, culture, and needs.

Pros of Out-of-Network Coverage

• Greater Choice in Providers – You can work with a therapist who feels like the right fit, even if they’re not in-network.

• Access to Specialized or Culturally Affirming Care – Some therapists offer services or approaches that aren’t available in-network.

• Partial Reimbursement – Your plan may cover part of your session cost, helping reduce out-of-pocket expenses.

Things to Consider

• Higher Out-of-Pocket Costs – Reimbursement is often lower than in-network coverage, and you may need to pay upfront and submit claims yourself.

• Deductibles and Limits – Some plans require you to meet a separate out-of-network deductible, and coverage may be capped per year.

• Paperwork – You’ll likely need to submit claims and documentation for reimbursement.

How to Check Your Out-of-Network Benefits

Before your first session, reach out to your insurance provider. The number is usually on the back of your card under “Behavioral Health” or “Mental Health.” If you don’t see that, call the general member services number and ask about Outpatient Mental Health Benefits.

Here’s what to ask:

1. Do I have out-of-network mental health coverage?

   • Your provider may ask for a CPT/service code:

     • Initial Evaluation – 90791

     • Individual Therapy Session – 90834

     • Couples/Family Therapy Session – 90847

   • If no: You can pay out-of-pocket or ask for help finding an in-network therapist.

2. Can I be reimbursed for my therapist’s license type?

   • Plans may only cover certain license types (e.g., LCSW, LPC, LMFT, Psychologist).

   • Confirm your therapist’s license and ask your insurance if that type is eligible for out-of-network reimbursement.

3. Do I have a deductible?

   • Ask how much it is and how much is left.

4. What is my co-insurance?

   • This is the percentage you pay. For example, if your plan reimburses 80%, you pay 20%.

   • Ask about the Usual and Customary Rate for your therapist’s zip code.

5. Is there a limit on how many mental health visits I can have per year?

6. Do I need an authorization for visits?

   • If yes, get the authorization number and number of sessions approved.

7. How do I submit a superbill for reimbursement?

   • Ask for the procedure and address to submit it.

If you run into questions or need help, we’re happy to guide you. Please note that Amani Nia Therapeutic Services cannot guarantee out-of-network reimbursement, but we’ll support you every step of the way.

Tips for Navigating Out-of-Network Benefits

• Focus on what feels right for you: choosing the therapist who fits your needs matters.

• Keep track of claims and reimbursements so nothing gets lost.

• Reach out—we can help you understand your benefits and make the process smoother.

We’re Here for You

Your care, your choice. If you want guidance on using out-of-network benefits, reach out here. We’ll honor your path to healing every step of the way.