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Some great therapists don’t take insurance.
And some great therapy clients don’t have nsurance or don’t want to use it.
And that’s okay.
There’s an amazing 3rd option that bridges the gap: out of network insurance for therapy.
Whether you're a therapist running an out-of-network practice or you’re a client wondering how to get reimbursed for sessions, this guide is for you.
Navigating out-of-network insurance can feel confusing at first.
But once you understand the basics, it opens the door to more flexibility, better-fit care, and more choice.
Here’s what you need to know.
When a therapist is “out-of-network,” it means they don’t have a contract with your health insurance provider. In-network therapists agree to accept a pre-negotiated rate from the insurance company. Out-of-network therapists haven’t signed that agreement, which means they set their own rates, and clients usually pay up front.
But that doesn’t mean clients can’t use their insurance. Many plans, especially PPOs (Preferred Provider Organizations), still offer some reimbursement for out-of-network care. In fact, for therapy, it’s often one of the only ways to access consistent, long-term mental health treatment without jumping through administrative hoops or running into session limits.
From the provider side, being out-of-network often means less paperwork, more control over rates, and greater freedom in how treatment is structured. Many therapists choose to stay out-of-network for those reasons.
For clients, it might sound like a hassle, but the right therapist may be worth it. And with the right process, reimbursement is often simpler than people assume.
It depends on the plan. Your plan.
Most PPOs and Point of Services (POS) plans include some level of out-of-network coverage, including for mental health care. These plans typically reimburse a percentage of the cost after the client meets their out-of-network deductible.
On the other hand, Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO) plans usually do not cover out-of-network services unless it’s an emergency.
Mental health parity laws require insurance companies to cover mental health services comparably to medical services. This doesn’t guarantee out-of-network coverage, but it does mean mental health care can’t be unfairly excluded.
Some clients may also be eligible for a network exception if no qualified specialists are available nearby. This is where the insurance company agrees to treat an out-of-network provider as in-network.
The No Surprises Act also protects clients in certain scenarios. For example, if a client sees a therapist at an in-network facility but the therapist turns out to be out-of-network, the client can’t be charged extra.
These laws help prevent unexpected costs, but they don’t apply to all plans, especially self-funded or limited benefit plans, so it’s essential to check the details.
Bottom line: coverage for out-of-network therapy varies, but it’s more common than many people think. Understanding the type of plan you're working with is the first step.
When a client works with an out-of-network therapist, they typically pay the full session fee upfront.
Afterward, they can file a claim with their insurance provider to request reimbursement. This process centers around a document called a superbill.
This is an invoice the therapist provides that includes service codes, fees, diagnosis codes (if applicable), and other required details.
Once the insurance company receives the superbill, they determine reimbursement based on the allowed amount for that service. This is a rate they’ve deemed reasonable for the type of care in the client’s geographic area.
However, this is not the actual fee the therapist charges. If the therapist charges $180 and the allowed amount is $120, the insurance might reimburse 60–80% of that $120, depending on the client’s plan and whether they’ve met their deductible.
In other words, the therapist charges $180, insurance pays $72-96, and the client pays the remainder.
Clients are responsible for the difference between what the therapist charges and what insurance covers. This is called balance billing, and it’s legal in most out-of-network scenarios. It’s important for therapists to explain this clearly so clients can plan accordingly.
Some savvy therapists or clients use services like Thrizer to automate claim submission and reduce back-and-forth. These tools help make reimbursement more accessible, even for clients new to the process.
Many clients (and even some new providers) assume that working with an out-of-network therapist means insurance won’t help at all. That’s one of the biggest myths. In reality, if the client’s plan includes out-of-network benefits, they can often be reimbursed for 50–80% of the session cost, especially after meeting their deductible.
Another common misconception is that the reimbursement process is too complicated. While it does require a few steps—paying upfront, getting a superbill, and submitting a claim—it’s not as overwhelming as it seems. Many therapists walk clients through the process or offer support services that simplify it.
Some clients worry that out-of-network therapy always costs significantly more. But depending on the plan, provider rate, and deductible status, the final out-of-pocket difference may be smaller than expected. In fact, after reimbursement, the client’s net cost could be comparable to in-network rates.
For therapists, there’s also the fear that being out-of-network will limit referrals or accessibility. But many clients are willing to use out-of-network benefits for the right fit, especially if the provider clearly explains the process and sets realistic financial expectations from the start.
If you’re a client working with an out-of-network therapist, your first step is to call your insurance company and ask a few key questions:
Once you know your benefits, make sure your therapist provides a complete superbill. This document should include:
Most claims can be submitted by mail, online, or through your insurance portal.
Accuracy is key. Even small errors like a typo in a name or the wrong date of birth can delay or deny a claim. Double-check everything before submitting. If your claim is rejected, you can usually appeal with corrected information, but it will take weeks or months.
Many therapists also offer onboarding or documentation support to make this process easier. And some clients choose to use tools or services that take care of insurance claims for them entirely, saving time and improving the odds of getting reimbursed.
If you’d like to try such a service, we invite you to view Thrizer’s Interactive Demo.
Federal protections have made it safer and more predictable to use out-of-network care in certain situations. The No Surprises Act, which went into effect in 2022, prevents clients from being balance billed in emergencies or when treated by an out-of-network provider at an in-network facility.
That means clients can’t be charged extra just because an anesthesiologist or radiologist wasn’t in-network, so long as the facility was.
However, this law doesn’t apply in all cases. If a client voluntarily chooses an out-of-network provider, the usual risks and costs still apply. That includes meeting a separate out-of-network deductible and potentially being balance billed for the difference between the provider’s rate and the insurance company’s reimbursement.
It’s also worth noting that many insurance plans, especially those sponsored by large employers, are self-funded and regulated federally, not by state laws. This limits the protection some clients might expect based on state mandates.
Therapists should stay informed and help clients understand what protections they do and don’t have. A little education upfront can prevent billing surprises later.
Using out-of-network insurance doesn’t have to be confusing or financially overwhelming—for clients or therapists. With the right tools and approach, it can be a flexible, sustainable option that puts care quality first.
For therapists, supporting clients with out-of-network benefits starts with clear communication and accurate documentation. Offering simple tools like automated superbills or access to support services can make a big difference in client retention and satisfaction.
For clients, choosing an out-of-network therapist means more freedom to work with someone who truly fits your needs. It may take a few extra steps, but the payoff is personalized care without insurance-driven constraints, and without needing to put a diagnosis (if applicable) on your medical records.
Out-of-network care is more than a backup plan. It’s a deliberate choice for better fit, deeper work, and more autonomy in the therapeutic relationship. With good information and support, it’s entirely within reach.
If you’re working in the out of network setting, consider giving Thrizer a try. We’re the out of network billing experts in your corner, making therapy more accessible and simple.
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This blog post is provided for informational purposes only and is not intended as legal, business, medical, or insurance advice. Laws relating to health insurance and coverage are complex, and their application can vary widely depending on individual circumstances and state laws. Similarly, decisions regarding mental health care should be made with the guidance of qualified health care providers. We strongly recommend consulting with a qualified attorney or legal advisor, insurance representative, and/or medical professional to discuss your specific situation and how the laws apply to you or your situation.
