Using an online therapy platform that doesn't accept your insurance doesn't mean you're stuck paying full price. If your health insurance has out-of-network benefits (most PPO and POS plans do), you can submit claims and get reimbursed for a significant portion of your therapy costs.
This guide walks you through the entire process—from checking your benefits to filing claims and getting paid.
How Out-of-Network Reimbursement Works
When you see a provider who isn't in your insurance network, your insurance may still cover part of the cost through out-of-network benefits. Here's the basic process:
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1
You pay the full amount upfront
Pay for your therapy subscription or sessions as usual with the platform.
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2
Get a superbill from your provider
Request an itemized statement with diagnosis codes, procedure codes, and provider info.
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3
Submit a claim to your insurance
File the superbill with your insurance company (online, by mail, or through an app).
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4
Get reimbursed
After meeting your deductible, insurance pays you back a percentage of the "allowed amount."
Step 1: Check Your Out-of-Network Benefits
Before anything else, verify that your plan has out-of-network coverage for mental health services. Call the number on your insurance card and ask these questions:
Questions to Ask Your Insurance
- 1. "Do I have out-of-network benefits for mental health/behavioral health services?"
- 2. "What is my out-of-network deductible?" (Often different from in-network)
- 3. "What percentage do you reimburse after the deductible?" (Usually 40-80%)
- 4. "What is the 'allowed amount' or 'usual and customary rate' for CPT code 90834?" (individual therapy)
- 5. "Is there a limit on the number of sessions covered per year?"
- 6. "What's the deadline to submit claims?"
⚠️ HMO Plans Usually Don't Have OON Benefits
If you have an HMO (Health Maintenance Organization) plan, you typically don't have out-of-network coverage. PPO and POS plans usually do. Check your plan type before going through this process.
Step 2: Get a Superbill
A superbill is an itemized receipt that includes all the information your insurance needs to process a claim. It's different from a regular receipt because it contains medical billing codes.
What a Superbill Must Include
Provider Information
- • Therapist's full name and credentials
- • License number
- • NPI (National Provider Identifier)
- • Tax ID number
- • Address and phone
Service Information
- • Date(s) of service
- • CPT codes (procedure codes)
- • ICD-10 codes (diagnosis codes)
- • Amount charged per session
- • Total amount paid
Which Platforms Provide Superbills?
| Platform | Superbills? | How to Get |
|---|---|---|
| Calmerry | Yes ✓ | Request through account settings or support |
| Online-Therapy.com | Yes ✓ | Contact support for documentation |
| BetterHelp | No ✗ | Only provides payment receipts (may work for some insurers) |
| Talkspace (self-pay) | Yes ✓ | Available in account for self-pay users |
| Regain | No ✗ | Same as BetterHelp (same parent company) |
If your platform doesn't provide superbills, you can ask your individual therapist to create one. Many therapists will do this even if the platform doesn't officially support it.
Step 3: Submit Your Claim
Once you have your superbill, submit it to your insurance. Most insurers accept claims through:
- • Online portal: Log into your insurance account and look for "Submit a Claim" or "Out-of-Network Claims"
- • Mobile app: Many insurers let you snap a photo of your superbill and submit
- • Mail: Download a claim form from your insurer's website, attach superbill, and mail
- • Fax: Some insurers still accept faxed claims
What to Include When Filing
- ✓ Completed claim form (if required by your insurer)
- ✓ Superbill with all required information
- ✓ Proof of payment (credit card statement or receipt)
- ✓ Your member ID and group number
Understanding Your Reimbursement
Your reimbursement amount depends on several factors. Here's how the math typically works:
Example Calculation
* This example assumes you've already met your out-of-network deductible
Important: Insurance reimburses based on their "allowed amount," not what you actually paid. If therapy costs $100/session but your insurer's allowed amount is only $80, they calculate your reimbursement from $80.
Automating the Process
Filing claims manually can be tedious, especially if you're submitting monthly. Several services can automate this:
Reimbursify
App that files OON claims for you. Upload your superbill, they handle the rest.
Cost: ~$4-6 per claim
Better
Helps maximize OON reimbursements with smart claim filing.
Cost: Percentage of reimbursement
Common Issues and Solutions
My claim was denied—what now?
Common reasons for denial and fixes:
- • Missing information: Get a corrected superbill and resubmit
- • Filed too late: Check if you can appeal the deadline
- • Service not covered: Ask which CPT codes are covered
- • No OON benefits: Your plan may not have them—verify plan type
You can always appeal denied claims—call your insurer for the appeals process.
The platform won't give me a superbill
How long until I get reimbursed?
Can I submit claims for past months?
The Bottom Line
Out-of-network reimbursement takes some effort, but it can significantly reduce your therapy costs—often by 40-60% per session. If you're using a cash-pay platform like Calmerry or paying out-of-pocket on Talkspace, it's worth checking your OON benefits and submitting claims.
Start by calling your insurance to verify benefits, request superbills from your platform or therapist, and submit claims within the deadline. Once you've done it once, the process becomes quick and routine.