Out-of-Network Mental Health Benefits: Frequently Asked Questions

Mental health care is more important than ever, but navigating insurance coverage — especially for out-of-network (OON) providers — can be confusing. At Uptown Downtown Psychotherapy, we aim to simplify the insurance process as much as possible. Here’s what you need to know.

What are out-of-network (OON) mental health benefits?

Out-of-network mental health benefits (OON), also known as out-of-network coverage, allow you to receive partial reimbursement from providers that are not part of your insurance provider’s network. Instead of paying a copay (as you would in-network), you are responsible for the full session fee upfront and then submit a claim for reimbursement.

How do I know if I have out-of-network benefits?

You can find out by:

• Logging into your insurance provider’s online member portal

• Calling the member services number (listed on the back of your insurance card) and asking specific questions like:

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

  • What is my deductible for out-of-network services? How much (if any) of that deductible has been met?

  • What percentage of the session fee is reimbursed once I meet my deductible?

How do I file a claim for reimbursement?

The steps for submitting a claim for reimbursement usually include:

1. Get a superbill from your therapist

2. Log into your insurance provider’s online member portal or complete a claim form

3. Upload or mail the superbill with the claim form

4. Wait for reimbursement (typically 2-4 weeks)

At Uptown Downtown Psychotherapy, we are able to submit claims on your behalf directly through our online system.

Can I submit a regular invoice for reimbursement?

No, you need a superbill. Insurance companies require a superbill, which is a specialized receipt that includes specific clinical information (e.g. your diagnosis code, CPT code, provider credentials, and tax ID). A standard invoice does not include this information and therefore is not a suitable document to submit to your insurance for reimbursement.

Final Thoughts

Your out-of-network mental health benefits can be a valuable tool for accessing the mental health care you need. Understanding your coverage, asking the right questions, and knowing how to file claims can help make therapy more affordable and accessible.

Have questions or need help understanding your benefits? Contact us — we’re here to support you every step of the way.