Simplifying Out-of-Network Therapy Benefits
A practical guide to understanding mental health benefits.
Navigating the U.S. healthcare system can feel like learning a second language—and mental health benefits are no exception. As a therapist in private practice, I often hear new clients say, “I have no idea if I have out-of-network benefits.”
If that sounds familiar, you’re not alone.
This post breaks down what those benefits mean, how to use them, and how to get reimbursed for therapy—even if your provider (like me) doesn’t accept insurance directly.
What Is Out-of-Network Therapy?
Many therapists, especially in places like New York City, operate outside of insurance networks. That means they’re not contracted with insurance companies—but that doesn’t mean you’re out of options.
If your insurance plan includes out-of-network (OON) benefits, you may be able to get reimbursed for a portion of your therapy costs after meeting your deductible.
Here’s the typical process:
Pay your therapist upfront.
Receive a Superbill (a detailed receipt for insurance reimbursement).
Submit the Superbill to your insurance provider.
Once your deductible is met, you receive partial reimbursement.
Yes, it’s a few extra steps, but it can make therapy significantly more affordable.
Understanding Key Insurance Terms
Let’s break down the most common insurance jargon:
Out-of-Network Benefits
If your therapist isn’t “in-network,” you’ll pay them directly, but your insurance might reimburse you later. Many PPO plans offer these benefits.
My practice is out-of-network, but we support clients in submitting Superbills.
Deductible
This is the amount you must pay out-of-pocket before your insurance starts covering services. This includes therapy and other healthcare services.
Co-Insurance
After you meet your deductible, your insurance might cover a percentage of the “allowed amount.” You’ll be responsible for the remaining percentage.
Example:
Therapy fee: $270
Insurance covers 70% of $200 (the “allowed amount”) = $140 reimbursed
Your final cost = $130
Allowed Amount
This is what your insurance company considers a “reasonable” session fee. Reimbursement is based on this number, not your therapist’s full rate. You’re responsible for the difference.
Make It Easy with Thrizer
We use a platform called Thrizer to simplify all of this.
Instead of calling your insurance company, navigating confusing portals, and waiting weeks for a check, Thrizer does the heavy lifting:
Verifies your out-of-network benefits
Shows your deductible, reimbursement rate, and out-of-pocket cost
Lets you submit Superbills or get reimbursed instantly
Handles everything directly with your insurance
If you're already in therapy or considering it, Thrizer can tell you in minutes whether you're eligible for reimbursement.
If your therapist isn’t using Thrizer yet, feel free to forward them this post!
Now Is a Great Time to Use Your Benefits
If you've already met your 2025 deductible and have out-of-network coverage, this is the perfect time to schedule therapy. You’ll get reimbursed before your deductible resets (most likely on January 1st).
Final Thoughts
I know insurance can feel overwhelming. But if you’re ready to start therapy—or you’re already paying out-of-pocket—it’s worth checking if you’re eligible for reimbursement.
And if you’re curious about your own benefits, I’m happy to check for you through Thrizer.
Looking for in-person therapy in NYC? We offer free consult calls to see if we’re a good fit. Reach out today to schedule a call.
More notes on therapy:
Julie Goldberg is a licensed therapist and the founder of Third Nature Therapy. Her practice focuses on helping individuals better understand their inner world, befriend their nervous system (instead of working against it), and navigate changing relationships. She offers somatic therapy, EMDR intensives, and Ketamine-Assisted Psychotherapy in Brooklyn, NY.