How to Use Out-of-Network Benefits for Therapy in Texas

One of the questions I hear most often from prospective clients is: “Can I use my insurance to see you?”

I don’t accept insurance directly, but that doesn’t necessarily mean your insurance can’t help pay for therapy.

If your plan includes out-of-network mental health benefits, you may be able to get reimbursed for a portion of your therapy sessions. I can provide SuperBills for clients who want to pursue reimbursement, and there are also services like Mentaya that can help you understand and use your out-of-network benefits.

If none of those words mean anything to you yet, that’s completely fine. Insurance language has a remarkable ability to make relatively simple things sound complicated.

Here’s what you actually need to know.

What are out-of-network therapy benefits?

When a therapist is “out of network,” it means they don’t have a contract with your insurance company.

I’m an out-of-network therapist. My clients pay me directly for their sessions rather than having me bill their insurance company.

But some insurance plans—particularly PPO plans—include out-of-network benefits. This means your insurance company may reimburse you for a portion of what you spend on therapy with an out-of-network therapist.

How much you get back depends entirely on your individual insurance plan, deductible, and your insurer’s allowed amount for the service.

So before deciding that private-pay therapy is outside your budget, I always think it’s worth checking.

What is a SuperBill?

This is another insurance term that sounds much more exciting than it actually is.

A SuperBill is essentially a detailed receipt for therapy that includes the information your insurance company needs to process an out-of-network claim.

It can include things like your therapist’s information, dates of service, session fees, diagnostic and service codes, and other details required by your insurance company.

In my practice, I don’t submit claims directly to insurance, but I can provide SuperBills for clients who want to seek reimbursement from their insurance company.

You then submit the SuperBill according to your insurance company’s process.

One important caveat: a SuperBill doesn’t guarantee reimbursement. Your insurance company ultimately decides whether a service is covered and how much it will reimburse.

How much could my insurance reimburse for therapy?

Unfortunately, there isn’t one percentage I can give you.

Two people paying exactly the same amount for therapy could have very different out-of-pocket costs because they have different insurance plans.

Your reimbursement may depend on:

• Your out-of-network deductible

• How much of that deductible you’ve already met

• Your out-of-network coinsurance rate

• Your insurance company’s allowed amount for psychotherapy

• Whether your particular plan covers out-of-network mental health services

For example, having “60% out-of-network coverage” doesn’t necessarily mean your insurance company will reimburse 60% of whatever your therapist charges. Insurance companies may calculate reimbursement based on their own allowed amount for the service.

This is why I recommend checking your actual benefits rather than trying to estimate them yourself.

How do I check my out-of-network mental health benefits?

The old-fashioned way is to call the member services number on the back of your insurance card.

When you call, specifically ask about your outpatient, out-of-network mental health benefits.

Some useful questions are:

• Do I have out-of-network benefits for outpatient psychotherapy?

• What is my out-of-network deductible?

• How much of that deductible have I already met?

• Once I meet my deductible, what percentage will my plan reimburse?

• Is mental health subject to a separate deductible?

• What is the allowed amount for an outpatient psychotherapy session?

• Do I need preauthorization?

• How do I submit an out-of-network claim?

• Is there a deadline for submitting claims?

Write down the answers—and ideally ask for a reference number for the call.

If calling your insurance company sounds like exactly how you don’t want to spend your lunch break, you can also look into a service like Mentaya, which helps people understand and use their out-of-network benefits.

Just remember that any benefits estimate is still an estimate. Your insurance company has the final say on reimbursement.

What if I don't want to deal with insurance claims myself?

Fair.

Submitting your own claims is absolutely an option, especially if your insurance company makes the process relatively simple.

But there are also services that help people manage out-of-network reimbursement. Mentaya, for example, can help with checking benefits and submitting eligible claims to insurance on a client’s behalf.

There is a fee associated with using their claim-submission service, so it’s worth comparing the convenience with simply submitting your own SuperBills.

You can learn more about how Mentaya works for therapy clients here.

You don't have to use a third-party service to work with me or receive a SuperBill. It's simply another option if dealing with insurance paperwork is something you'd rather outsource.

What if I have a high deductible?

A high deductible can mean you won’t receive reimbursement immediately.

But that doesn’t necessarily mean submitting your claims is pointless.

Eligible out-of-network expenses may count toward your out-of-network deductible. If you eventually meet that deductible during the year, your insurance may then begin reimbursing eligible expenses according to your plan.

That’s one reason I recommend understanding your benefits early rather than discovering six months into therapy that you could have been submitting claims all along.

Is private-pay therapy worth it?

This is ultimately a personal decision.

Insurance can make therapy more affordable, and for many people, staying within their insurance network makes the most financial sense.

But there are also reasons someone might choose an out-of-network therapist.

Sometimes you find someone whose approach, personality, lived experience, or specialty feels particularly aligned with what you’re looking for. Maybe you've been searching specifically for someone who understands ADHD, creative lives, identity, relationships, cultural belonging, or a major transition you're moving through.

For me, the relationship between therapist and client matters enormously.

Therapy is personal. Finding someone you actually feel comfortable talking to—and someone you believe understands the way you move through the world—is worth considering alongside cost and insurance coverage.

Out-of-network benefits can sometimes make that choice more financially accessible.

Working with me

I work with adults who are often trying to understand themselves more deeply rather than simply “fix” a symptom.

Many of my clients are creatives and artists, adults with ADHD or differently wired brains, expats and third-culture adults, and people navigating identity, relationships, midlife, or major life transitions.

My approach is rooted in existential therapy, with IFS/parts work, attachment-informed therapy, and mindfulness woven into our work together.

I see clients in person in Austin and virtually throughout Texas.

I don’t accept insurance directly, but I can provide SuperBills if you have out-of-network benefits and would like to seek reimbursement.

If you're curious about working together, I offer a free 20-minute consultation. It's a chance for us to talk about what’s bringing you to therapy, what you're looking for, and whether we feel like a good fit.