Out-of-Network Therapy, Superbills, and Private Pay

If you have been researching therapy options, you have probably run into terms like “out-of-network,” “superbill,” and “private pay.” For many people, these insurance terms can feel confusing and overwhelming. This guide breaks down what these terms actually mean, how they work together, and what questions to ask before you book your first session. 

What does “in-network” vs. “out-of-network” mean?

When a therapist is “in-network,” it means they have a contract with your insurance company. The insurer has agreed to pay a negotiated rate for sessions, and your cost is typically limited to a copay or coinsurance after your deductible is met. 

An “out-of-network” therapist does not have that contract. They may not accept your insurance at all, or they may simply not be listed as a preferred provider on your specific plan. Whether your insurance covers any portion of their services depends entirely on your plan’s out-of-network benefits. 

What is private pay (also called cash-pay or self-pay)? 

Private pay means you pay your therapist directly for each session, without involving your insurance company. You are not billed through insurance, and your insurer is not notified of your treatment. 

Private pay offers several potential benefits: 

• Greater privacy and confidentiality 

• More flexibility in treatment planning 

• No insurance-required diagnosis in some situations 

• Access to therapists who may not be in your insurance network 

• Freedom to choose the therapist who is the best fit for your needs 

While private pay requires paying upfront, many clients are surprised to learn that they may still be able to use their insurance benefits through out-of-network reimbursement. 

What is a superbill for therapy? 

If your therapist doesn’t accept insurance, you may still be able to get partially reimbursed by submitting a superbill for out-of-network care. Many private-pay therapists can provide a superbill upon request. 

A superbill is a detailed receipt that your therapist provides after each session. It contains everything your insurance company needs to process a potential reimbursement claim, including: 

• Your therapist’s name, license number, and NPI (National Provider Identifier) 

• The date and duration of the session 

• The CPT code (a standardized service code, most therapy sessions are billed as 90837 for 60 minutes or 90834 for 45 minutes) 

• Your diagnosis code (ICD-10), if applicable (usually required for “medical necessity” insurance billing). 

• The full fee charged and the amount you paid 

You submit the superbill directly to your insurance company, typically through their member portal, by mail, or by fax. Your insurer reviews it and, if your plan includes out-of-network mental health benefits, reimburses you directly for the covered portion. 

Will my insurance actually reimburse me?  

It depends on the type of plan you have. Here is a quick breakdown: 

• PPO plans (Preferred Provider Organization): Most PPO plans include out-of-network benefits, which means superbill reimbursement is often possible. You will typically need to meet your out-of-network deductible first, after which your plan reimburses a percentage of the “allowable amount” (their benchmark rate for that service). 

• HMO plans (Health Maintenance Organization): HMO plans generally do not cover out-of-network providers except in emergencies. Superbill reimbursement is rarely available with an HMO. 

• EPO plans (Exclusive Provider Organization): Similar to HMOs — out-of-network coverage is typically not included. 

• High-deductible plans (HDHP): May have out-of-network benefits, but your deductible must be met before reimbursement kicks in. These plans pair well with HSA accounts (see below). 

Before your first session, call the member services number on the back of your insurance card and ask specifically: 

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

• What is my out-of-network deductible, and how much have I already met this year? 

• What percentage of the allowable amount does my plan reimburse for CPT code 90837? 

• How do I submit a superbill claim? 

Getting these answers in writing (or at minimum noting the date, time, and representative’s name) protects you if there is ever a dispute. 

Can I use my HSA or FSA for private pay therapy? 

 Yes. Psychotherapy is a qualified medical expense under IRS guidelines, which means you can use funds from a Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for sessions. This applies whether your therapist is in-network or not. 

Because HSA and FSA contributions are made with pre-tax dollars, using these accounts effectively reduces the cost of therapy by your marginal tax rate (typically 20 to 30 percent for most households). If you have funds available in either account, this is one of the most straightforward ways to make private pay therapy more affordable. 

What are the advantages of private pay beyond cost? 

Many clients choose private pay for reasons that have nothing to do with network availability: 

• Privacy: No diagnosis is required to begin therapy when you pay privately, and your treatment is not reported to your insurer or added to your insurance medical record. 

• No session limits: Insurance companies can restrict how many sessions they will authorize. Private pay removes that ceiling entirely. 

• More choice: You can select a therapist based on specialization and fit rather than network status. 

• Faster access: In-network waitlists can be long. Private pay clients often have greater scheduling flexibility. 

How does The Halliday Center handle this? 

At The Halliday Center, some of our clinicians work with insurance plans and some operate on a private-pay basis. We are transparent about this from the start, and we are glad to help you understand your options before you commit to anything. 

If your clinician is private pay, we can provide superbills for every session so you can seek reimbursement from your insurer directly. Our Client Care Advocates are also happy to walk you through the questions to ask your insurance company and help you figure out what your plan actually covers. 

Ready to take the next step? Call us at (760) 635-3310 (Option 1) or contact us online. We’re happy to answer your questions and help you find the right fit.