Choosing between in-network and out-of-network therapy

Understanding the differences between in-network and out-of-network therapy can help you make a more informed choice about your mental healthcare. Insurance billing can affect how much you pay for therapy, which therapists you can see, and if your plan helps cover the cost.

Choosing between in-network and out-of-network therapy often comes down to a few key factors. These include your insurance benefits, your budget, the therapists available to you, and how important it is to work with a specific provider. Knowing what to expect when it comes to costs, coverage, and therapist options can help you focus less on the logistics of care and more on healing. 

What’s out-of-network therapy?

Out-of-network therapy means seeing a therapist who doesn’t have a contract with your insurance company. Instead of paying an in-network rate, you may pay the therapist’s full fee. Depending on your insurance plan, you may be able to submit a claim and get part of that cost reimbursed.

Benefits of out-of-network therapy

One of the biggest benefits ^[1] of out-of-network therapy is having more choices of providers. You may decide to see an out-of-network therapist because they specialize in your needs, have availability that works for you, or simply feel like the right fit. 

For some people, going out of network may also make it easier to find available care. Research ^[2] found that people used out-of-network providers more often for behavioral healthcare than for medical or surgical care.

Therapists may also choose to stay out of network. Working directly with clients allows them to set their own rates and spend less time dealing with insurance requirements and billing.

A common misconception is that insurance never helps pay for out-of-network therapy. Some plans do offer out-of-network benefits. However, coverage varies, and you may need to meet a separate deductible before your plan starts paying.

What to consider before choosing out-of-network therapy

The biggest concern is usually cost. You may need to pay the full session fee up front, and reimbursement isn’t always guaranteed. Out-of-network care can also involve more paperwork if you need to submit claims yourself.

Before starting therapy, check your plan’s out-of-network benefits, deductible, and reimbursement rules. This can give you a clearer idea of what therapy may cost and help you avoid unexpected bills.

How to see an out-of-network therapist

If you’re considering an out-of-network therapist, these steps can help you understand what to expect:

1. Check your benefits. Review your insurance plan or call your insurer to ask whether you have out-of-network mental health benefits. Preferred provider organization (PPO) plans are more likely to offer them, while many health maintenance organization (HMO) plans don’t.

2. Ask about costs. Find out your out-of-network deductible, coinsurance, and reimbursement rate. You may need to pay the therapist’s full fee until you meet your deductible.

3. Confirm how payment works. With out-of-network therapy, you’ll often pay the therapist directly at the time of service.

4. Ask about reimbursement. Your therapist may give you a superbill, which is a detailed receipt you can submit to your insurance company. Your plan will decide how much, if anything, it reimburses.

5. Be ready for more paperwork. With in-network therapy, billing and insurance claims are often handled for you. Out of network, you may need to submit claims, track your deductible, and follow up with your insurer yourself.

Before starting care, it can help to ask your insurance company exactly what it covers so you have a clearer idea of your expected costs.

What’s in-network therapy?

In-network therapy means seeing a therapist who has a contract with your insurance company. The therapist agrees to charge rates set by your insurance plan, which often means you pay less for each session.

Some benefits and limitations of in-network therapy include:

• Lower costs: You may only need to pay a copay or coinsurance after meeting your deductible.

• Less paperwork: The therapist typically submits insurance claims for you, making billing easier to manage.

• Fewer choices: Your options are limited to therapists who accept your insurance. This can make it harder to find someone with the right specialty, location, or availability.

• Possible wait times: Depending on your plan and where you live, in-network therapists may have limited openings.

For many people, in-network therapy offers a simpler and more affordable way to use their mental health benefits. However, it’s still important to consider if the therapists in your network meet your needs.

How to find an in-network therapist

If you want to use your insurance benefits for therapy, these steps can help you get started:

1. Check your insurance directory. Log in to your insurance account or visit your insurer’s website to search for therapists listed as in network.

2. Narrow your options. Look for therapists who have experience with your concerns and offer the type of care, location, or schedule you need.

3. Confirm coverage. Before your first appointment, ask the therapist’s office to confirm that they accept your specific insurance plan. You can also contact your insurer to double-check.

4. Ask about your cost. Find out whether you’ll owe a copay, coinsurance, or deductible, so you know what to expect before starting therapy.

With in-network therapy, the therapist usually handles the insurance claim for you, which can make the billing process simpler.

Is in-network or out-of-network better?

When it comes to in-network vs. out-of-network therapy options, there’s no one right answer as for which one is best. The right choice depends on your budget, insurance benefits, and what you’re looking for in a therapist.

In-network therapy may be a better fit if keeping costs predictable is your main concern. Out-of-network therapy may give you more choices, which can be helpful if you’re looking for a specific specialty or therapist.

Cost is often the biggest factor to consider. Research ^[3] has found that people generally pay more out of pocket for out-of-network therapy than for in-network care. Before choosing, compare your copay or coinsurance, deductible, and any out-of-network benefits. Also consider if you’ll need to pay the full session fee up front and wait for reimbursement.

Ultimately, the best option is one that gives you access to the care you need at a cost you can manage over time.

Tips to maximize your insurance

A few extra steps can help you get more from your mental health benefits:

• Verify coverage before starting. Make sure your therapist and specific plan are a match before your first appointment.

• Use available benefits. Check if your plan covers services like telehealth or other forms of mental healthcare.

• Plan for your deductible. Your costs may change once you meet your deductible, so keep track of where you stand throughout the year.

• Save your paperwork. Keep bills, superbills, and insurance statements in case you need to submit a claim or question a charge.

• Review your benefits each year. Insurance plans and therapist networks can change, so don’t assume your coverage will stay the same.

If something about your coverage is unclear, ask your insurance company for details before starting care. Knowing what your plan covers can make it easier to choose care that works for your needs and budget.

Clinician’s take

Insurance paperwork can start to take up a lot of mental space when you’re already trying to focus on your well-being. Ask your therapist if they can email your superbill after each session or on a regular schedule, so it’s one less thing you have to remember. Setting aside a specific time to deal with reimbursement can also help keep financial stress from taking over your therapy time.

Brandy Chalmers, LPC

Clinical reviewer