UNDERSTANDING OUT-OF-NETWORK THERAPY

Ana María Paniagua, LCSW
May 5
4 min read

A simple guide to help you make informed choices about your mental health care

By Ana María Paniagua, LCSW | The Healing Office

WHAT DOES “OUT-OF-NETWORK” MEAN?

When a therapist is out-of-network (OON), it means they don’t bill your insurance company directly. Instead, you pay for each session upfront, and if your plan includes out-of-network benefits, you can submit a claim to get some of that money reimbursed.

This is different from in-network therapy, where your therapist is already partnered with your insurance company. In-network therapists handle the billing for you, and you usually only pay a co-pay or part of your deductible.

WHY DON’T SOME THERAPISTS TAKE INSURANCE?

Therapists structure their practices in different ways depending on what works best for them and the people they support. Some work in-network. Others don’t.

Here are a few reasons why some therapists choose not to panel with insurance:

They may offer services that aren’t always covered (like EMDR intensives, somatic therapy, or certain trauma-focused approaches)
They may prefer to offer longer or more open-ended sessions that don’t always fit standard insurance models
They may want to keep therapy private unless a client chooses to share a diagnosis with insurance

It’s not about one being better than the other—it’s about how they’re set up. What matters is that the care feels right for you.

WHAT ARE THE BENEFITS OF OUT-OF-NETWORK THERAPY?

If you're considering working with someone out-of-network, here’s what that can offer:

More freedom in choosing a therapist: You’re not limited to providers listed by your insurance company
Access to niche or specialized support: Some therapists with specific training or focus areas are only available out-of-network
A more flexible structure in some cases: Depending on the provider, sessions may be longer or spaced differently
More choice about what information is shared: Some clients prefer not to have a mental health diagnosis submitted unless they’re requesting reimbursement

WHAT ARE THE BENEFITS OF IN-NETWORK THERAPY?

If you prefer to go through your insurance, in-network therapy may offer:

Lower out-of-pocket costs: You may only need to pay a co-pay or meet a lower deductible
Less administrative work: Your therapist bills the insurance company directly, and you don’t need to file claims
Easier access for short-term or solution-focused therapy: Many people get what they need through a covered number of sessions

IS ONE BETTER THAN THE OTHER?

Not at all. Choosing between in-network and out-of-network therapy isn’t about which is “better.” It’s about which option fits your needs, your preferences, and your financial situation.

Some people value convenience and affordability. Others want a specific kind of therapy or flexibility in structure. There’s no wrong answer.

What matters most is that you feel safe, supported, and seen in the therapy process.

A REAL-LIFE EXAMPLE: WHAT YOU MIGHT PAY OUT-OF-NETWORK

Let’s say:

Each session costs $110
Your insurance covers 80% of out-of-network therapy
You have a $100 deductible

Here’s how that could look:

Session	You Pay	Insurance Reimburses	Your Real Cost
1	$110	$0 (goes toward deductible)	$110
2	$110	$88	$22
3	$110	$88	$22

This is just one example. Some plans reimburse less or more, and some have higher deductibles. That’s why it helps to check.

HOW TO CHECK IF YOUR PLAN COVERS OUT-OF-NETWORK THERAPY

Option 1: Call Your Insurance Company

Flip your insurance card over and call the number for “Member Services.” Ask:

Do I have out-of-network benefits for outpatient mental health?
What’s my deductible—and how much of it have I already met?
What percentage of the session cost is reimbursed after I meet my deductible?
How many sessions are covered per year?
Do I need a diagnosis, pre-authorization, or a referral?
How do I submit claims?

Write it all down while you’re on the call—it’s easy to forget details later.

Option 2: Use a Tool to Help with Claims

If you don’t want to fill out paperwork yourself, these platforms can help you figure out your benefits and submit claims:

Most have free versions. You just upload your receipt (or "superbill") and they handle the rest.

HOW TO FIND AN IN-NETWORK THERAPIST

If you want to stay in-network, you can search for a therapist through:

Headway – Lets you book with in-network therapists and handles billing
Alma – Shows therapists by insurance plan
Psychology Today – Filter by insurance, specialty, and location
ZenCare – Includes video profiles and insurance filters
Your insurance provider’s website – Search for therapists under "Behavioral Health" or "Mental Health"
Mindful Care – Offers therapy and medication management with insurance
Open Path Collective – Low-fee therapy, not insurance-based but good for affordability

FINAL THOUGHTS

There are many ways to get support. Whether you go through insurance or not, the most important thing is working with someone you trust—someone who helps you feel heard, grounded, and understood.

If you're unsure how to start or what your plan covers, I’m happy to help you figure it out. The path to support doesn’t need to be overwhelming—you don’t have to navigate it alone.

This article is informed by clinical experience, health insurance research, and trauma-informed therapy practices. It’s designed to help you better understand your options for mental health care, especially when navigating insurance. It is not a substitute for therapy or financial advice. If you're feeling overwhelmed or unsure where to start, a licensed therapist can walk with you through the process—step by step, at your pace.

REFERENCES

American Psychological Association. (2023). Paying for therapy. https://www.apa.org/topics/psychotherapy/paying-for-therapy

National Alliance on Mental Illness. (n.d.). Understanding health insurance. https://www.nami.org/Your-Journey/Individuals-with-Mental-Illness/Understanding-Health-Insurance

Zaya Health. (2024). Out-of-network therapy guide: What to expect. https://www.zaya.health/resources/out-of-network-guide

Reimbursify. (2023). How reimbursement works. https://www.reimbursify.com/how-it-works

HealthCare.gov. (n.d.). What’s the difference between in-network and out-of-network care?https://www.healthcare.gov/glossary/in-network-out-of-network/