Out-of-Network Therapy After Insurance Resets: How to Use Your Benefits Without Limiting Your Options
January tends to bring two things at the same time.
A renewed interest in therapy.
And a whole lot of confusion about insurance.
Insurance plans reset, deductibles start over, and suddenly people who were finally ready to look for a therapist are stuck wondering if they can even afford it. Many people assume that if a therapist is out of network, insurance is completely off the table.
That is not always true.
If you are looking for therapy in Schertz, Cibolo, or the greater San Antonio area, understanding out-of-network benefits can open up far more options than most people realize.
This post breaks it down in plain language so you can decide what actually works for you.
What “out of network” really means
When a therapist is in network, they have a contract with your insurance company and are paid directly by insurance.
When a therapist is out of network, there is no contract. This usually means:
You pay the therapist directly at the time of service
You may be able to request reimbursement from your insurance plan, depending on your benefits
Out of network does not automatically mean insurance will not help. It simply means the insurance company is not paying the therapist directly.
For many people, out-of-network therapy allows more freedom to choose a therapist based on fit, specialty, and approach rather than being limited to a short list.
Why January is a smart time to look at out-of-network benefits
At the beginning of the year:
Deductibles reset
Benefits change
Costs feel unpredictable
That makes January an ideal time to pause and ask:
What does my plan actually cover?
Do I have out-of-network mental health benefits?
What would reimbursement look like if I chose a private-pay therapist?
Clarity here can reduce stress and prevent surprises later.
Therapy can be accessible and realistic
Let’s hold two things at the same time.
Therapy should feel accessible and not like something only a few people can afford.
Therapy is also a real investment of time, energy, and money.
Both are true.
A lot of people avoid even exploring therapy because insurance feels overwhelming. But often, one phone call can give you enough information to make a grounded, informed decision.
Step-by-step: How to check your out-of-network therapy benefits
Step 1: Gather your insurance information
You will want:
Your insurance card
The member services phone number
Your plan type (PPO, HMO, etc.)
PPO plans are more likely to offer out-of-network benefits, but the only way to know for sure is to ask.
Step 2: Call your insurance company
Yes, calling insurance is rarely anyone’s favorite activity. Think of it as short-term annoyance for long-term clarity.
Ask for behavioral health benefits, then ask these questions:
Do I have out-of-network benefits for outpatient mental health therapy?
Is there a separate out-of-network deductible, and how much is it?
What percentage or amount do you reimburse for out-of-network psychotherapy?
Is there a limit on the number of sessions per year?
Do I need preauthorization?
Which CPT codes are reimbursable?
Common ones include 90791 (initial assessment) and 90837 (50-minute therapy).Are reimbursements based on the provider’s full fee or an allowed amount?
Write down the answers, the representative’s name, and a reference number if one is provided. Future You will appreciate this.
Step 3: Understand the real numbers
Out-of-network reimbursement often depends on:
Whether your deductible has been met
Your reimbursement percentage
Your plan’s allowed amount
This means reimbursement may be lower early in the year and increase later once deductibles are met. Knowing this upfront helps set realistic expectations and reduces frustration.
What is a superbill?
A superbill is a detailed receipt that includes the information insurance companies typically require to process out-of-network claims. It usually includes:
Provider information
Dates of service
Diagnosis and service codes
Fees paid
Clients can submit superbills to their insurance company to request reimbursement if their plan allows it.
Insurance companies ultimately decide what they reimburse, but superbills give you the documentation needed to try.
Two common ways people handle reimbursement
Option 1: Submitting superbills yourself
Some people prefer to handle claims on their own. This usually looks like:
Paying for your session
Receiving a superbill
Submitting it through your insurance portal or by mail
Waiting for reimbursement
This works well for people who do not mind paperwork and follow-up.
Option 2: Using a claims support tool like Thrizer
Thrizer is a claims support tool that helps clients understand out-of-network benefits and navigate the reimbursement process. Many people choose this option because it reduces the mental load and back-and-forth with insurance.
If insurance already feels overwhelming, using a support tool can make the process feel far more manageable.
What therapy costs in real numbers
Private-pay therapy rates vary by provider and specialty. In this area, many trauma-informed therapists charge rates that reflect advanced training and smaller caseloads.
A common rate you may see is $150 for a 50-minute session.
Some people receive partial reimbursement. Some receive more later in the year. Some choose private pay because the quality of care and fit matter more to them than insurance involvement.
There is no single right choice; only the one that works best for your needs and resources.
Why understanding out-of-network benefits expands your options
When you understand how out-of-network benefits work, you are no longer limited to:
Short provider lists
Long wait times
Therapists who may not specialize in what you need
Instead, you can focus on finding the best fit while still using insurance benefits when available.
That flexibility matters, especially when you are seeking therapy for anxiety, trauma, or long-standing overwhelm.
A local note for Schertz and surrounding areas
At Flourish Therapy and Wellness, in-person therapy is offered at 1996 Schertz Parkway, Suite 402, Schertz, TX, which is easily accessible for clients in Schertz, Cibolo, and Northeast San Antonio. Telehealth options are also available, depending on your needs and preferences.
A gentle reality check
Insurance systems are not designed to feel regulating. Feeling overwhelmed by them does not mean you are doing anything wrong.
Therapy does not have to be all or nothing. Sometimes the first step is simply understanding how your benefits work so you can make an informed choice.
Clarity is often the first form of relief.
Moving forward this year
If therapy has been on your mind, consider starting here:
Call your insurance company and ask about out-of-network mental health benefits
Write down what they tell you
Decide whether submitting superbills yourself or using a claims support tool feels best
Look for a therapist who feels like a good fit, not just one who appears on a list
You deserve care that works for you: practically, emotionally, and financially.
