How to Use Your PPO Insurance for Out-of-Network Therapy in California

What "Out-of-Network" Actually Means

When a therapist is out-of-network, it means they don't have a direct billing agreement with your insurance company. You pay the therapist directly — and then, if you have a PPO plan, you can submit a claim to your insurance for partial reimbursement.

This is different from an HMO plan, which typically only covers in-network providers. If you have a PPO, you likely have out-of-network benefits — it's worth checking.

Step 1: Call the Member Services Number on Your Insurance Card

Before your first session, call your insurance company and ask these specific questions:

• Do I have out-of-network mental health benefits?
• What is my out-of-network deductible, and how much have I met?
• What percentage of the allowed amount does my plan reimburse for outpatient mental health?
• Do I need prior authorization for outpatient therapy visits?
• How do I submit an out-of-network claim?

Step 2: Get a Superbill From Your Therapist

A superbill is a detailed receipt that includes everything your insurance company needs to process a claim: the therapist's license number and NPI, the date of service, the diagnosis code, and the procedure code (usually 90837 for a 53-minute session).

Ask your therapist to provide a superbill monthly or after each session, depending on your preference.

Step 3: Submit Your Claim

Most insurance companies let you submit claims online through their member portal, or by mail. Attach the superbill and complete the claim form your insurance provides. Keep copies of everything.

Reimbursement timelines vary — typically 2 to 6 weeks. You'll receive a check or direct deposit for the covered portion, minus your deductible and any coinsurance.

What to Expect Financially

Here's a simplified example: if your plan covers 70% of the allowed amount after a $500 deductible, and the allowed amount is $150, you'd be reimbursed $105 per session once your deductible is met. Your actual out-of-pocket would be the session fee minus that reimbursement.

It takes some upfront cost and paperwork, but for many people it significantly reduces the overall expense of therapy.

HSA and FSA

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), therapy sessions are typically an eligible expense. You can pay your session fee directly from those accounts, which means you're using pre-tax dollars — an effective discount of 20–35% depending on your tax bracket.

If you have questions about the superbill process or what to ask your insurance company, feel free to reach out. Navigating this shouldn't be a barrier to getting support.

About the Author

Tracey Nguyen, LMFT

Tracey is a Licensed Marriage & Family Therapist (LMFT #146704) offering telehealth therapy across California. She specializes in anxiety, depression, trauma, relationships, and perinatal mental health — and offers sessions in both English and Vietnamese.

Work with Tracey →