Out-of-Network Benefits for Online Trauma Therapy

I’m Jennifer L. Hillier, M.A., LPC-S, with Mending Hearts Counseling. I provide online therapy for adults in Texas, Colorado, Florida, and Vermont. If your plan includes out-of-network mental health benefits, you may be able to seek reimbursement for eligible sessions with me. Your insurer can tell you whether your specific plan covers online therapy and what you would need to submit.

How Do Out-of-Network Therapy Benefits Work?

Out-of-network benefits may reimburse part of the cost of therapy when you choose a provider not contracted with your insurance plan. Not every plan includes this coverage, and the amount you receive depends on your deductible, coinsurance, reimbursement rate, and the plan’s allowed amount for each service. Call the Member Services or Behavioral Health number on the back of your insurance card to confirm your specific benefits and learn how to submit claims.

Questions to Ask About Your Out-of-Network Therapy Benefits

Call the Member Services or Behavioral Health number on the back of your insurance card and ask:

• Does my plan include out-of-network benefits for outpatient mental health therapy delivered through telehealth?

• Do I have an out-of-network deductible, and how much of it remains?

• After I meet the deductible, what percentage of the allowed amount will the plan reimburse?

• What is the allowed amount for an initial assessment (CPT 90791) and an individual therapy session (CPT 90837)?

• Do I need prior authorization or a referral?

• Is there a limit on the number of therapy sessions covered each year?

• How do I submit a superbill or claim for reimbursement?

• Is there a deadline for submitting claims?

• How long does reimbursement usually take?

• Are reimbursements paid directly to the provider or to me?

• Does another company manage the behavioral health benefits for my plan?

If you have an HMO plan, ask whether out-of-network mental health care is covered at all or whether a network-gap exception or prior approval may be available.

Write down the date of the call, the representative’s name or identification number, and the call-reference number. Insurance quotes are not guarantees of payment, but detailed notes can help if a claim is processed differently than you were told.

If your plan does not cover out-of-network therapy, you can still explore self-pay, HSA, and FSA options for online therapy.