How to Use Out-of-Network Benefits for Therapy (A San Diego Therapist’s Guide to Getting Reimbursed)
If you’ve been searching for low-cost therapy, affordable therapy in San Diego, or even “free therapy near me,” you’ve probably noticed something confusing:
Many experienced therapists don’t take insurance. And at first glance, that can feel like a deal-breaker.
I hear this concern almost daily from new clients. People assume that if a therapist is out-of-network, therapy will automatically be unaffordable or that insurance won’t help at all. But here’s the part almost nobody explains, you can often still use your insurance and get a large portion of your therapy sessions reimbursed, even if your therapist does not accept insurance. This is called using out-of-network benefits, and once you understand it, therapy becomes far more accessible than it initially appears.
This guide will walk you step-by-step through exactly how it works, how much money you can get back, and how many of my San Diego therapy clients end up paying less than their gym membership per week for sessions.
What Does “Out-of-Network” Mean?
Insurance companies divide healthcare providers into two categories:
In-network providers are Therapists who have contracts with your insurance company and agree to a pre-set rate and rules.
Out-of-network providers
Therapists who do not contract with insurance but whose services may still be partially covered by your plan.
Many people think out-of-network means insurance won’t pay anything. That is incorrect. If your plan includes PPO benefits (and many employer plans do), your insurance company will reimburse you directly after sessions. Instead of the therapist billing insurance, you pay for the session and insurance pays you back.
Why Many Experienced Therapists in San Diego Don’t Accept Insurance
This part matters because it answers a question people often don’t ask out loud, “Why would a therapist not take insurance if they want to help people?” Insurance companies heavily control therapy. When therapists contract with insurance, they must:
Provide a mental health diagnosis
Share treatment information
Follow session limits
Accept reduced reimbursement rates
Sometimes receive payment months later
Many therapists choose to remain out-of-network so they can:
• Protect your privacy
• Avoid labeling you unnecessarily
• Provide longer-term care
• Offer personalized treatment
• Focus on burnout, stress, perfectionism, and life transitions — not only severe mental illness
This is especially relevant for adults seeking therapy for anxiety, work stress, or feeling overwhelmed. Insurance companies typically only approve care when symptoms reach a medical threshold. Ironically, waiting until you are at a breaking point is often the only way insurance fully covers treatment. Out-of-network therapy allows people to get help earlier, when therapy is actually most effective.
The Biggest Misconception: “Out-of-Network Therapy Is Too Expensive”
Here is what many people don’t realize: Your insurance may reimburse 50–80% of each session.
So while the session fee might be $200, your real cost could be closer to:
$40
$60
$75
Sometimes $0 after your deductible
This is why many clients searching for affordable therapy are surprised to learn they already have coverage. For some plans, therapy effectively becomes low-cost therapy and occasionally close to free therapy after reimbursements.
Step 1: Check If You Have Out-of-Network Mental Health Benefits
You can do this in about 10 minutes. Call the number on the back of your insurance card and ask specifically for the behavioral or mental health department. Use this exact script:
“I am planning to see an out-of-network therapist. Can you help me understand my out-of-network outpatient mental health benefits?”
Then ask these questions:
Do I have out-of-network mental health coverage?
What is my deductible?
How much of my deductible has been met?
What percentage do you reimburse per session?
What is the allowed amount per session?
Do I need preauthorization?
Where do I send superbills?
Write down the answers.
The two most important numbers are Your deductible and Your reimbursement percentage
What Is a Deductible?
Your deductible is the amount you pay before insurance starts reimbursing you. For example, If your deductible is $1,000 You pay the full session fee until you’ve spent $1,000 on healthcare that year. After that, insurance begins paying their portion. Some clients meet their deductible quickly because it counts across all medical care (doctor visits, labs, urgent care, and prescriptions). Once met, therapy becomes significantly cheaper.
What Is a Superbill?
A superbill is simply a receipt for therapy that includes the information insurance needs. Your therapist provides it to you (usually monthly). You submit it to your insurance company, and they send you reimbursement. You are not filing a claim incorrectly. You are using a benefit your plan already includes. In order to submit the superbill, there are typically three easy ways: Upload through your insurance portal, Email it to claims, Use a reimbursement app (many PPO plans support this). Typical reimbursement time is about 2–4 weeks and the insurance company will send the payment directly to you.
Real Example of Therapy Cost
Let’s say a Session fee is about $200 and Insurance reimbursement is 70%
After deductible is met, many clients in San Diego end up paying roughly $70–$100 per session, which falls directly into the range people search when looking for low-cost therapy options.
Why Using Out of Network Benefits Can Be Better Than In-Network Therapy
People assume in-network automatically equals cheaper. Not always. In San Diego especially, in-network therapists often:
• Have long waitlists
• Offer limited availability
• Restrict session frequency
• Require diagnoses for ongoing care
Out-of-network therapy offers:
Consistent weekly sessions
Flexible scheduling
Greater privacy
No session caps
Individualized treatment
And sometimes… a similar out-of-pocket cost
Privacy Matters More Than You Think
When you use in-network therapy, insurance receives:
Your diagnosis
Your treatment plan
Medical necessity documentation
Session frequency
Records if audited
Your mental health becomes part of your permanent medical record.
Out-of-network therapy significantly limits how much information insurance receives. For many professionals (especially those in leadership roles, this matters). This can also be relevant for first responders and military personnel who feel more comfortable with more concrete confidentiality.
When Therapy Becomes “Free Therapy”
While therapy is rarely literally free, there are situations where reimbursement effectively covers sessions:
• After a deductible is met
• If you’ve had medical expenses earlier in the year
• During pregnancy or childbirth year
• After surgeries or hospital care
In those cases, insurance may reimburse nearly 100% of therapy for the remainder of the calendar year. Many clients unintentionally have months of covered therapy available and never use it.
Who Benefits Most From Out-of-Network Therapy?
Out-of-network therapy is especially helpful if you:
Feel chronically overwhelmed
Struggle to turn work off mentally
Overthink decisions constantly
Tie self-worth to productivity
Have anxiety but still function well
Avoid asking for help
Appear successful but feel exhausted
Insurance typically does not classify these as “severe enough,” yet they deeply affect quality of life. This is exactly where therapy is most impactful. Preventative care where clients can learn coping skills, stress, management, and communication skills before they are already at their wits end can prevent burn out and severity of symptoms that could lead to stress leave.
Common Fears About Using Benefits
“I’m bad with paperwork.” Submitting a superbill takes about 3 minutes once you do it once.
“I’ll get denied.” If your plan includes out-of-network mental health coverage, reimbursement is expected and not unusual.
“Insurance will contact my employer.” They cannot. This is protected health information.
“I’ll do it wrong.” Your therapist typically guides you step-by-step the first time.
Why This Information Isn’t Widely Explained
Insurance companies don’t actively promote out-of-network reimbursement because fewer people use it. Therapists don’t always explain it clearly because they assume it’s confusing.
As a result, many people spend months searching for affordable and easily accessible therapy while already holding usable benefits.
Final Thoughts
If you’ve been putting off therapy because of cost, this is often the missing piece.
Out-of-network benefits are not a loophole. They are a standard part of many PPO insurance plans.
Understanding how to use them can make therapy accessible sooner, before stress becomes burnout, before anxiety escalates, and before you reach a crisis point.
You don’t need to wait until things are falling apart to justify getting support.
Ready to Start Therapy in San Diego?
I help adults who feel constantly “on,” mentally exhausted, and stuck in cycles of overthinking, pressure, and burnout. Therapy focuses on practical tools, boundaries, and changing the patterns that keep life feeling heavier than it needs to be.
If you’re unsure whether your insurance includes out-of-network benefits, I can help you check and walk you through the process.
Reach out here:
therapybykimberlin.com
Or email:
therapybykimberlin@gmail.com
FAQ | Frequently Asked Question
So how much does therapy cost in San Diego?
Therapy costs in San Diego can vary widely depending on the therapist’s training, specialty, and whether they accept insurance. In-network therapy often involves a copay that ranges from about $20–$50 per session, but availability can be limited and waitlists are common. Private pay therapists typically charge between $150–$250 per session in this area.
However, many people don’t realize their PPO insurance plan may include out-of-network mental health benefits. With reimbursement, clients frequently receive 50–80% of the session fee back after their deductible is met. That means a $200 session may actually cost closer to $70–$100 out of pocket. Some clients pay even less later in the year once their deductible has been satisfied through other medical visits. Because of this, therapy can become far more affordable than expected, and in certain cases close to the cost of a typical weekly wellness expense.
