How to check your coverage

Written By Leslie Moore

If you’ve noticed that I am an out-of-network provider, you might be wondering what that actually means for you financially. The good news is that many clients, especially those with PPO insurance plans often receive partial reimbursement for therapy. Even if you have an HMO plan, or want to use a Health Savings Account (HSA) or Flexible Spending Account (FSA) card, there are ways to make therapy accessible and potentially reimbursable.

Here’s a simple guide to help you understand how it works and how to check your benefits.

Step 1: Call the Member Services Number on Your Insurance Card

On the back of your insurance card, you’ll see a Member Services phone number. Call that number and let them know you’re seeking outpatient mental health therapy with an out-of-network licensed therapist.

Step 2: Ask These Questions

You can read these off to the representative:

  • Do I have out-of-network benefits for outpatient mental health therapy?

  • Can I use my HMO or PPO plan for out-of-network care with a referral?

  • What is my out-of-network deductible, and how much of it has been met?

  • Once my deductible is met, what percentage do you reimburse for out-of-network therapy sessions?

  • Is there a limit to the number of sessions covered per year?

  • Do I need pre-authorization?

  • How do I submit claims for reimbursement?

Understanding Deductibles and Payment Options

Many people are surprised that even “in-network” therapy may require meeting a deductible before insurance coverage begins. Sometimes, the difference between in-network and out-of-network costs is smaller than expected once your deductible is met.

Out-of-network therapy can also be paid with an HSA or FSA card, giving you flexibility and potential tax advantages while still accessing specialized care. HMO clients may also be eligible for partial reimbursement with a referral.

What Is a Superbill?

A superbill is a detailed receipt for therapy services that includes all the information your insurance company needs to process reimbursement.

I provide superbills at the end of each month. You simply submit the superbill to your insurance company (often through their online portal), and they reimburse you based on your out-of-network benefits.

Why Some Clients Choose Private Pay

Even with insurance, clients often choose out-of-network therapy because it offers:

  • Greater privacy (sometimes no diagnosis required for reimbursement)

  • More flexibility in treatment approach

  • Access to specialized care (adjustment, life transition, relationship, performance-focused therapies, etc.)

  • No session limits dictated by insurance

  • Ability to focus on quality of care rather than insurance restrictions

Specialized therapy can feel like a big commitment, but it’s an investment in your mental health, relationships, and day to-day well-being. Many clients notice that the insight, coping skills, and relief they gain make it worthwhile.

Leslie Moore