Using out-of-network benefits for psychiatry allows you to choose your provider based on expertise, approach, and connection, rather than just their network status. This option gives you greater flexibility and access to specialized care that might not be available through your plan’s network, though it typically involves more upfront costs and paperwork compared to in-network care.
Out-of-network benefits are a feature of some insurance plans – typically PPO (Preferred Provider Organization) and POS plans – that allows you to see a provider who is not in your insurance company’s contracted network and still receive some level of coverage. These benefits allow you to work with any licensed provider you choose, then receive reimbursement for a portion of the cost.
Instead of your provider billing theceipt, called a “superbill,” which you can submit to your insurance company for reimbursement directly, you pay for your care at the time of service. We then provide you with a special rent.
In-Network: These providers have signed contracts with your insurance company to accept negotiated rates and bill insurance directly. You typically pay only a small copay or coinsurance at the time of service. Your choice is limited to providers within this network.
Out-of-Network: These providers, like Revival Psych, haven’t signed these contracts with your insurance company. This gives our professionals the freedom to create treatment plans – from medication management to therapy – based solely on your needs, not an insurance company’s protocols.
Many specialized mental health practices choose to be out-of-network for several important reasons, all of which center on providing a higher quality of care:
Freedom of Treatment: In-network providers are often bound by insurance rules about type, frequency, and duration of care. By operating out-of-network, our team can offer comprehensive services like thorough psychiatric evaluations or innovative treatments like ketamine treatment without external restrictions.
More Time with You: Insurance-based practices often see high patient volumes to manage administrative costs. The OON model allows providers to dedicate more time to each person, fostering stronger therapeutic relationships.
Enhanced Privacy: In-network providers must share diagnosis and treatment details with insurance companies. As an out-of-network practice, we share only the information you choose to submit via your superbill, giving you greater control over your private health information.
Navigating your benefits can feel complex, but it breaks down into a few key steps and terms. Our team is here to help you understand your specific situation.
The first step is to confirm your coverage. You can do this by:
Calling Your Insurer: Call the member services number on your insurance card and ask specifically about “out-of-network mental health benefits” or “out-of-network behavioral health coverage”
Checking Your Online Portal: Log in to your insurance provider’s website and look for your plan details or summary of benefits
Letting Us Help: Use our insurance info to send us your insurance details. Our team will verify your benefits and provide a clear breakdown before your first visit
Key questions to ask:
Do I have out-of-network benefits for mental health?
What is my annual out-of-network deductible, and how much have I met?
What percentage of the UCR is covered for CPT codes 99204 (new patient evaluation) or 90834 (therapy session)?
Is there a separate mental health deductible?
How do I submit a for reimbursement?
If your plan includes OON benefits, it will typically cover a percentage of the cost of your care after you’ve met your deductible. For example, your plan might cover 50-80% of the “allowable” amount for a therapy session. This means you are responsible for the remaining percentage (your “coinsurance”) plus any amount of the provider’s fee that exceeds the insurer’s set rate.
The process is straightforward:
You attend your appointment at Revival Psych (e.g., for therapy or a new patient consultation)
You pay for the full cost of the session at that time
We provide you with a superbill
You submit the superbill and a form to your insurance company
Your insurer processes the and sends you a check for the covered amount
A superbill is a detailed, itemized receipt that contains all the information your insurance company needs to process your reimbursement . This includes:
The provider’s information (name, address, license number, tax ID)
Your personal information and diagnosis code (ICD-10)
The date and type of service provided (CPT code)
The amount you paid
At Revival Psych, our administrative team ensures superbills contain all necessary information for smooth processing.
The “Usual and Customary Rate” (UCR), also called the “allowable amount” or “allowed amount,” is the maximum amount your insurance company deems reasonable for a specific service in your geographic area. Insurance companies calculate this based on data from similar providers in Mesa, AZ.
For example, if our fee for a session is $300, but your insurer’s UCR is $250, they will calculate your reimbursement based on the $250 amount, not the $300 you paid.
Understanding the financial side of things is crucial. Here’s how to calculate your costs and what to expect from the reimbursement process.
Let’s walk through an example:
Your Provider’s Fee: $350 for a psychiatric evaluation
Your OON Deductible: $1,000 (not yet met)
Your Insurer’s UCR: $300
Your Coinsurance: 20% (insurance pays 80%)
Before Deductible is Met: You pay the full $350. The $300 UCR applies toward your $1,000 deductible. You now have $700 remaining on your deductible. No reimbursement yet.
After Deductible is Met: Once you’ve paid $1,000 out-of-pocket, your benefits kick in. For the next $350 session:
Insurance covers 80% of the $300 UCR = $240
Your cost: $60 (20% coinsurance) + $50 (difference between fee and UCR) = $110
Your reimbursement: $240
For out-of-network care, you always pay the provider’s full fee at the time of service. The reimbursement is a separate transaction between you and your insurance company that happens later. Some practices may offer payment plans or accept credit cards to help manage these upfront costs.
Before meeting your out-of-network deductible (often higher than in-network), you’re responsible for 100% of the allowed amount. However, these payments count toward your deductible. Keep submitting even if you’re not getting reimbursed yet – you’ll establish a history and may receive retroactive reimbursement once the deductible is met.
Most insurance companies process out-of-network within 30-45 days. Electronic submission through your insurer’s website or app is typically faster than mailing paper. Direct deposit can speed up payment by another 3-7 days compared to mailed checks. During busy periods like January, processing may take longer.
Yes, both Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) can pay for out-of-network psychiatric services. Mental health services, including psychiatry and therapy, are eligible expenses regardless of network status. Using these pre-tax dollars effectively reduces your out-of-pocket cost by the amount you would have paid in taxes.
Here’s a simple roadmap for getting started with out-of-network psychiatry benefits.
Before your first appointment, contact your insurance or use our insurance info. Write down:
Your out-of-network deductible amount and how much you’ve met
Coinsurance percentage after deductible
Any annual or lifetime maximums
Whether prior authorization is required for psychiatric services
Different rates for psychiatrists versus therapists
Filing deadlines (typically 90-180 days)
After each appointment at Revival Psych, request a superbill. Confirm it includes all required elements: provider information, your information, date of service, CPT codes, diagnosis codes, and amount paid. Our team ensures superbills are properly formatted with all necessary information.
Submit through your insurance company’s website, mobile app, or by mail. Include the superbill and any required forms. Take photos or make copies before submitting. Most companies allow you to track status online, so create an account if you haven’t already.
Monitor your ‘s progress through your insurance portal. If denied or pending additional information, respond promptly. Keep records of all submissions and reimbursements for tax purposes and to track deductible progress.
Choosing an OON provider is an investment in your well-being. Here’s how to ensure it’s the right decision for you.
Using out-of-network benefits makes sense when:
You need specialized care for conditions like treatment-resistant depression, ADHD, or PTSD
You’re seeking specific treatments like SPRAVATO® therapy
You prefer a specific provider’s expertise and philosophy
You value shorter wait times, longer appointments, and personalized attention
Privacy and confidentiality are top priorities
Track Everything: Keep a spreadsheet of appointments, payments, and submitted
Submit Regularly: Don’t wait – submit superbills monthly to maintain cash flow and track deductible progress
Use Your HSA/FSA: Take advantage of pre-tax accounts for out-of-pocket costs
Time It Right: Schedule appointments early in the year if you have other medical expenses that will help meet your deductible
Bundle : If your plan allows, submit multiple together to save time
Pros:
Greater choice and access to specialized experts
More personalized and flexible treatment plans
Increased privacy and confidentiality
More time dedicated during appointments
Shorter wait times for appointments
No insurance-mandated session limits
Cons:
Higher initial out-of-pocket costs
You handle submissions
Reimbursement amounts uncertain until processed
Must budget for full payment upfront
Out-of-network benefits allow you to see any provider, giving you freedom to choose the expert who fits your needs
You pay upfront and submit a “superbill” for reimbursement of 50-80% after meeting your deductible
Revival Psych helps verify your benefits and provides proper documentation
HSAs and FSAs can cover out-of-network psychiatric services with pre-tax dollars
Electronic submission speeds up reimbursement (2-3 weeks vs 4-6 weeks for paper)
HMO plans rarely offer out-of-network benefits, while PPO and POS plans typically do
About the Author
Erin Jones
