Out-of-Network and Self-Pay Therapy: What It Means, How It Works, and Why It’s Worth It
When looking for a therapist, you’ve likely come across terms like “self-pay” and “out-of-network,” and wondered what they actually mean. With so much confusing insurance jargon, navigating the therapy process can feel overwhelming.
In this post, I will walk you through what self-pay and out-of-network therapy mean, how to use your insurance benefits, and why this route may offer more supportive, personalized care.
What Does “Out-of-Network” Therapy Mean?
Health insurance plans typically have a list of providers who are considered in-network. These are therapists or medical professionals who have a contract with the insurance company and have agreed to provide services at a set rate, determined by the insurance company.
Out-of-network (OON) therapists are providers who don’t have a contract with your insurance company. That means they set their own rates, and you pay them directly. However, many insurance plans offer partial reimbursement for out-of-network therapy, depending on your benefits.
How Does Out-of-Network Therapy Work?
Here’s a basic overview of how it usually works:
You pay your therapist directly (typically at the time of each session).
Your therapist gives you a superbill, which is essentially a detailed receipt.
You submit the superbill to your insurance company.
If your plan covers out-of-network care, you get reimbursed a percentage of the session fee.
Example: Let’s say your therapist charges $130 per session, and your insurance plan reimburses 60% of the allowed amount after your deductible is met. If the insurance’s allowed amount is lower than the therapist’s fee (for example, $130 charged but $100 allowed) you would receive 60% of $100 ($60) back, making your total cost $70 per session.
Self-Pay vs. Out-of-Network: What’s the Difference?
Self-pay and out-of-network (OON) therapy both involve paying your therapist directly, but there’s an important distinction:
Self-pay means you are choosing not to use insurance at all. You pay the full session fee out of pocket, and no superbill or reimbursement is involved.
Out-of-network therapy means you still pay upfront, but you can submit a superbill to your insurance company for potential reimbursement if your plan includes OON benefits.
Benefits of Self-Pay Therapy
Maximum privacy: no diagnosis is required, and nothing is shared with insurance.
No restrictions: you can choose the frequency, duration, and type of therapy that’s right for you.
Simplicity: no paperwork or reimbursement process to manage.
What to Ask Your Insurance Company About Out-of-Network Benefits
If you’re thinking about working with an out-of-network therapist, it’s a good idea to call your insurance company and ask a few key questions. Here’s a script you can use, along with helpful questions:
"Hi, I’d like to check my out-of-network benefits for mental health counseling with a licensed professional counselor (LPC).”
Questions to ask:
Do I have out-of-network benefits for outpatient mental health services?
What is my out-of-network deductible, and how much of it has been met?
What percentage of the session fee is reimbursed, or how much per session?
Are CPT codes 90834 (45 min) or 90837 (60 min) covered?
Is there a limit on the number of sessions per year?
Do I need pre-authorization or a referral from a primary care provider?
What documentation is required to submit a claim?
How do I submit a superbill or claim for reimbursement?
Knowing these details can help you make an informed decision and prepare for the financial side of therapy.
Why I Choose to Be Out-of-Network and Self-Pay
Many clients understandably ask: Why wouldn’t you take insurance to make things easier?
The short answer: I want to provide higher-quality, more personalized care.
Insurance panels often require therapists to carry very high caseloads, limit session length or frequency, and prioritize documentation over client care. Beyond these challenges, working with insurance can involve spending hours on the phone going back and forth just to get claims approved or payments processed. Sometimes, insurance companies delay payments, recoup funds years later after initially paying (known as “clawbacks”), or take years before increasing reimbursement rates for therapists. These tasks take time and energy away from what truly matters: supporting you.
By staying out-of-network, I can maintain a smaller caseload, which allows me to:
Dedicate more time and energy to each client
Stay up-to-date with trainings, research, and best practices
Offer care tailored to you, not dictated by insurance restrictions
Maintain a non-pathologizing, collaborative approach
Prepare thoughtfully for our sessions
Reflect between appointments to track your progress
Why People Choose Out-of-Network Therapy
While it can seem easier to stick with in-network therapists, many people choose to go out-of-network for a few important reasons:
Greater Choice and Specialization: Your healing journey is deeply personal. Out-of-network therapy allows you to find the best fit therapist for you. You can find a therapist who specializes in your unique needs, whether that’s trauma, EMDR, anxiety, faith integration, or complex relational issues. You’re not limited by insurance panels, so you can choose someone truly aligned with your goals and values.
Greater Privacy and Confidentiality: Insurance companies require detailed records and diagnoses. When you pay out of pocket, your care stays between you and your therapist. You don’t have to worry about insurance companies requiring formal diagnoses or detailed records that might feel intrusive or stigmatizing.
Personalized Treatment: Out-of-network therapists have the flexibility to design sessions that fit your pace, not a predetermined insurance schedule. Whether you need longer sessions, more frequent appointments, or a different therapeutic approach, you have the freedom to shape your care in a way that truly supports your healing.
Unhurried Care: Many insurance plans limit the number of covered therapy sessions per year, sometimes to as few as 6 or 8. This can cut short your progress or force you to pause treatment. Out-of-network therapy removes those restrictions, allowing you to continue your journey without artificial limits.
More Availability: In-network therapists can have long waitlists. Out-of-network providers may have more flexibility to get started sooner and offer session times that work for you.
Is Out-of-Network Therapy Right for You?
It may be worth exploring out-of-network therapy if it is important to you to find the best fit therapist for you - someone who understands your experience, specializes in your concerns, and can offer consistent, individualized care.
If you have a PPO plan or out-of-network benefits, you might be surprised how much your insurance can reimburse. Reimbursement rates vary depending on your specific plan, but many PPO plans reimburse anywhere from 40% to 80% of the session fee after you've met your out-of-network deductible.
Final Thoughts
Investing in your mental health is one of the most meaningful choices you can make. While out-of-network therapy may involve more upfront cost, it also offers more flexibility, privacy, and personalized care.
If you’re looking for therapy that prioritizes depth, quality, and connection, I’d love to support you. Have more questions or want to explore working together? Schedule a free consultation.
Michaela Zoppa is a Licensed Professional Counselor (LPC) in Colorado. She supports women and teen girls navigating anxiety, perfectionism, trauma, and burnout.
