Ask a Medical Biller: Can I See an Out-of-Network Therapist?

When most individuals start the process of looking for a therapist, seeing an out-of-network provider is not often considered. It is widely believed that seeing a provider inside of your insurance network is easier and more affordable. However, you may be surprised to find out that your out-of-network insurance coverage could mimic your in-network insurance coverage. That means seeing the provider you want with little to no added cost.  

In today’s world of insurance coverage, the vast majority of health insurance policies include out-of-network mental health benefits. It is as easy as picking up the phone and calling your insurance provider to find out what is covered through your insurance plan.

 Not sure where to begin with your insurance or out-of-network benefits? Follow these steps, and by the end of your conversation with your insurance representative you will fully understand your out-of-network benefits and how they will be used when seeing an out-of-network therapist:

  • Call the member services phone number on the back of your insurance card and ask for the benefits department


  • Ask the representative if you have out-of-network mental health benefits – if yes ask these additional questions


  • What is my out-of-network deductible for outpatient mental health?


  • How much of my deductible has been met this year?


  • What is my out-of-network coinsurance for outpatient mental health? 


  • Will I have a copay after my deductible and coinsurance are met?


  • Do I need a referral from an in-network provider to see someone out-of-network?


  • How do I submit for reimbursement?

Once you have obtained this information, you will want to call the providers office and ask to speak with the billing department or administrator who handles insurance. Explain to that representative you have contacted your insurance and know what your out-of-network benefits are. The office representative will be able to provide you with specific pricing information and explain to you how claim submission will be handled.  

And that’s it! In no time, you can be working on your mental health and life goals with the provider of your choosing, not just the person covered by your insurance plan.