What Your Therapist Wishes You Knew About Insurance (Part 2 of 4): In-Network vs Out-of-Network — What's the Difference?
This is Part 2 of a 4-part series on using insurance for therapy.
Part 2: In-Network vs Out-of-Network — What's the Difference? (you are here)
Part 3: Why You Might Get a Surprise Bill — Even With Insurance (coming soon)
Part 4: When Insurance Isn't an Option — Other Ways to Make Therapy Work (coming soon)
In Part 1, I covered why mental health billing works differently from regular medical billing, including the diagnosis requirement, how insurers can influence treatment decisions, and why reimbursement rates affect therapist availability.
In this part, I want to get practical. If you're trying to figure out whether to see an in-network or out-of-network therapist, here's what those terms actually mean and how to make the decision that's right for you.
What "In-Network" Means
In-network means your therapist has a contract with your insurance company. They've agreed to accept the insurer's set rate as payment, and your insurance pays them directly once you've met your deductible and paid your share (usually a copay or coinsurance).
This is typically the most affordable option if your plan has strong mental health benefits because your insurer is covering most of the cost and your out-of-pocket expense per session is predictable.
The tradeoff is that your choices are limited to therapists who have agreed to those contracts. And as I mentioned in Part 1, not every therapist accepts every plan or any plan at all.
What "Out-of-Network" Means
Out-of-network means your therapist doesn't have a contract with your insurer. You pay the full session fee upfront, and depending on your plan, your insurance may reimburse you for a portion of that cost after you submit a claim.
The key phrase there is depending on your plan. Some plans, particularly HMOs, offer little to no out-of-network coverage. Others, particularly PPOs, include meaningful out-of-network mental health benefits that many clients don't even know they have.
The Question You Should Ask Your Insurance Company Right Now
Before you assume you can only afford an in-network therapist, call the member services number on the back of your insurance card and ask this exact question:
"Do I have out-of-network mental health benefits? If so, what is my out-of-network deductible, and what percentage of the session fee will you reimburse after I meet it?"
You might be surprised by the answer. Some clients find that after their out-of-network deductible is met, their plan reimburses 50–70% of each session fee, which can make seeing the therapist who's the right fit nearly as affordable as an in-network option.
What Is a Superbill?
If you're seeing an out-of-network therapist and want to seek reimbursement from your insurance, a superbill is how you do it.
A superbill is an itemized receipt that contains all the information your insurance company needs to process a reimbursement claim:
Your therapist's name, license type, and tax ID
The diagnosis code assigned to your treatment
The CPT service code for the type of session
The date of service and fee paid
At Mindful Kindness Counseling, I provide superbills to clients who request them. Here's how the process works:
You pay for your session at the time of service
I provide you with a superbill
You submit it to your insurance company — most allow this through their online member portal or by mail
Your insurance processes the claim and, if your plan includes out-of-network benefits, mails or deposits a reimbursement check directly to you
The reimbursement amount varies widely by plan. Some clients get back 50–80% of the session fee after their deductible is met. Others receive nothing. The only way to know what to expect is to verify your specific out-of-network benefits before you start, which is always worth doing.
So Which Option Is Right for You?
Here are a few questions to help you think it through:
Does your plan have strong in-network mental health benefits? If your copay is low, your deductible is manageable, and there are no session limits, in-network is probably your most affordable path — as long as you can find an in-network therapist who's a good fit and has availability.
Do you have out-of-network benefits worth using? If your plan is a PPO and your out-of-network reimbursement rate is 60–70%, the math may work in your favor — especially if the therapist you want to see isn't in your network.
Is fit more important than cost? Sometimes the therapist who is genuinely right for you isn't in your network. In those cases, it's worth running the numbers on what out-of-network reimbursement would look like before ruling it out.
Are you comfortable having a diagnosis on your record? Either path — in-network or out-of-network with reimbursement — requires a diagnosis. If that's a concern, it's worth discussing with your therapist before you decide how to proceed.
In Part 3, I'll cover something that trips up even well-prepared clients: why you can do everything right and still end up with a surprise bill. It happens more than it should, and understanding why can help you protect yourself.
Questions? Let's Talk.
If you're trying to figure out whether in-network or out-of-network makes more sense for your situation, feel free to bring it up in our consultation call. It's exactly the kind of thing I'm happy to help you think through.
Request a free 15-minute consultation call →
Bonnie Scott is a Licensed Professional Counselor-Supervisor (LPC-S) in San Antonio, TX. She offers individual therapy, couples counseling, and LGBTQ+ affirming care in person and via telehealth throughout Texas.
