I am not being entirely tongue-in-cheek when I say that trying to get insurance to cover treatment for mental health problems like depression, anxiety, bipolar disorder, and post-traumatic stress disorder (PTSD) can itself cause or exacerbate those very problems.
According to a 2026 analysis by the health policy research organization KFF, insurers selling plans through the federal HealthCare.gov marketplace denied 19% of in-network claims and 37% of out-of-network claims in 2024. These figures include claims for physical and mental healthcare, and not every denial was improper. Still, they illustrate how difficult it can be for patients to obtain reimbursement for care.
Often, in my experience, insurers will make you wait on hold for many minutes or even hours, repeating the same information about yourself over and over again before they explain why they will not pay for your care. Whether or not this frustration is intentional, the system often seems designed to wear people down until they give up.
It is no exaggeration that trying to get insurance companies to pay for care can itself contribute to stress and anxiety, particularly among populations such as military personnel, humanitarian workers, and first responders, who may already have difficulty asking for help.
Nonetheless, it is important to make sure you are accessing benefits that are owed to you rather than avoiding a process that, frustrating as it may be, can ultimately help you afford treatment and support a fuller recovery. You owe this to yourself, your loved ones, and the community you serve.
As a therapist, I spend anywhere from one to five hours each week on the phone with patients' insurance companies, trying to get them to pay for services that should be covered. Sometimes, insurers simply fail to process claims that I have submitted with all the necessary information. Sometimes, a coding issue—the wrong number used to designate telehealth services, for example, or a changed member identification number that has not been updated—prevents payment.
If I don't make these maddening calls, it's possible that my patient and I won't be able to continue treatment together. So I do my best.
Often, however, it is easier and more effective for patients themselves to call their insurance companies to find out what is necessary to get a claim paid. After all, patients are the policyholders or covered members, and insurers have a contractual obligation to administer their benefits. In my experience, a call from the patient can sometimes resolve a problem faster than repeated calls from the provider.
This is also one reason why accessing out-of-network care can open up a wider range of provider choices for many patients, though certainly not all.
Many private insurance plans, particularly preferred provider organization (PPO) plans, offer out-of-network benefits. TRICARE Select, the military health insurance program, also allows beneficiaries to see eligible providers who are not part of its network.
Depending on your plan, you may be able to see a doctor or therapist, pay out of pocket, and then submit something called a superbill—an itemized statement documenting the services you received and their cost—to obtain reimbursement directly from your insurance company.
TRICARE Select offers an especially useful example. It allows beneficiaries to see TRICARE-authorized providers outside its network, although deductibles, cost-shares, reimbursement limits, and provider participation rules affect what patients ultimately pay.
As someone covered by TRICARE Select myself, I have found that understanding these distinctions can make a substantial financial difference.
That is why, whether you are a service member, veteran, military family member, or someone with private health insurance, it can pay to explore out-of-network treatment options rather than limiting yourself to providers listed in your insurance company's directory.
Here are six things to keep in mind.
1. Find out exactly what your out-of-network mental health benefits cover.
If you have private insurance, start by asking whether your plan includes out-of-network benefits for outpatient mental health treatment.
If it does, ask what percentage of the allowed amount your insurer will reimburse.
The allowed amount is the maximum amount your insurance plan recognizes for a particular service. It is not necessarily what the therapist charges, nor is it necessarily the amount the insurer pays an in-network provider.
For example, suppose you see a therapist for a 45-minute session, which is generally billed under CPT code 90834 (psychotherapy lasting 38–52 minutes).
Your therapist charges $120 for the session, but your insurance company recognizes only $75 as the allowed amount. If your plan reimburses 60% of that amount after your deductible has been met, your insurer would pay you $45.
You would initially pay your therapist $120, submit your superbill, and receive $45 back.
Your final cost would be $75 instead of $120.
Some plans reimburse a higher percentage of the allowed amount; others reimburse less. Some do not offer out-of-network benefits at all.
Ask your insurer for the allowed amounts for CPT codes 90834 and 90837 (psychotherapy lasting 53 minutes or longer), as well as the percentage your plan pays after the deductible.
Then multiply the allowed amount by the reimbursement percentage and subtract that figure from your therapist's fee.
That is your estimated cost per session once your deductible has been met, assuming the service is covered and no additional restrictions apply.
2. Ask about your out-of-network deductible.
While you're on the phone, ask whether you have a separate out-of-network mental health deductible.
A deductible is the amount of covered expenses you must pay before your insurance begins contributing toward those expenses. You may have an in-network deductible that is substantially lower than your out-of-network deductible.
For example, if your out-of-network deductible is $2,000, you generally must satisfy that deductible before your plan starts reimbursing you for covered out-of-network treatment.
There is an important complication: the amount credited toward your deductible may be the insurer's allowed amount, not the full fee you pay your therapist.
If your therapist charges $120 but your insurer recognizes only $75, your plan may credit only $75 toward your deductible.
Ask whether your in-network and out-of-network deductibles are separate, how much you have already satisfied, and exactly how your out-of-network expenses are credited.
These details can make a tremendous difference in what treatment ultimately costs.
3. Make sure your provider and treatment are eligible for reimbursement.
Before beginning treatment, find out whether your insurance plan will reimburse you for services provided by the therapist you want to see.
Start by asking your therapist for their National Provider Identifier, or NPI.
There are two types of NPIs:
Type 1 NPI: Identifies an individual healthcare provider.
Type 2 NPI: Identifies a healthcare organization, such as a group practice or other eligible business entity.
Some therapists have only a Type 1 NPI, while others also practice through an organization with a Type 2 NPI. Ask for both, if applicable, and provide whichever identifiers your insurer requests.
You should also have the provider's name, practice name, and the CPT code typically used for your sessions: 90834 for 38–52 minutes or 90837 for 53 minutes or longer.
These details will help the insurer give you more accurate information about your benefits and reimbursement rates.
Your insurance company may be reluctant to disclose its allowed amounts, sometimes describing them as proprietary information. If you cannot get a clear answer, ask to speak with a supervisor or request a written explanation of how your reimbursement will be calculated.
You should also ask whether your particular diagnosis and treatment are covered.
Your therapist may need to provide a diagnostic code from the International Classification of Diseases (ICD), which is used for insurance billing. Mental health diagnoses are also described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).
Federal and state mental health parity laws provide important protections against insurers imposing more restrictive financial requirements or treatment limitations on covered mental healthcare than on comparable medical or surgical care. These laws do not, however, guarantee coverage for every diagnosis or service.
For example, couples counseling undertaken primarily to address relationship difficulties may not be covered, while medically necessary psychotherapy for a diagnosed mental health condition may be eligible for reimbursement. Autism-related services may also be covered, depending on the treatment, plan, and applicable laws.
Your therapist should always use the diagnosis and service codes that accurately reflect the treatment being provided.
4. If your provider isn't recognized by your insurer, find out what it would take to change that.
If your insurance company tells you that your provider is not eligible for reimbursement, don't necessarily stop there.
Ask whether the provider needs to complete credentialing, certification, or another authorization process.
This is particularly relevant for TRICARE, which distinguishes between network providers and TRICARE-authorized non-network providers.
A therapist does not necessarily have to join the TRICARE network for eligible services to be reimbursable. However, the provider generally must meet TRICARE's authorization requirements.
Sometimes, patients can help facilitate this process by obtaining the appropriate forms and giving them to their providers.
As a TRICARE Select beneficiary, I have done this myself to facilitate coverage for a family member's speech therapy. The result was thousands of dollars in savings.
It is worth making that extra phone call.
5. Find out how to submit a superbill.
Before hanging up with your insurer, ask exactly what information your superbill must contain and how you should submit it.
A superbill is a detailed statement from your healthcare provider that gives your insurance company the information it needs to process a claim.
Some insurers have online portals where you can upload your superbill. Others require a claim form or additional documentation.
Companies such as Reimbursify also offer services designed to simplify out-of-network claims submission. Through an app, patients can enter insurance and provider information and submit claims without repeatedly navigating their insurer's paperwork.
These services may charge fees, and they cannot guarantee that your insurance company will approve or reimburse a claim.
In many cases, however, submitting a superbill yourself is straightforward enough that you do not need to pay a third-party company.
As a provider, I often help patients with this process to make accessing care as smooth as possible.
6. Submit your superbill and follow up until your claim is processed.
Once you have confirmed your out-of-network coverage, verified that your provider and treatment are eligible, and paid for your sessions, ask your therapist for a superbill.
A complete superbill will typically include your provider's name, address, NPI, tax identification information when required, your diagnosis code, the dates of service, the CPT codes for each service, and the amounts charged. You may also need to provide proof of payment.
Submit the superbill according to your insurer's instructions, along with any required claim form.
Keep copies of everything you submit, and make a note of the date.
If you do not receive reimbursement or an explanation within the applicable claims-processing period, follow up. Ask for a claim or reference number, document whom you speak with, and request written confirmation of the claim's status.
If your claim is denied, ask for a written explanation that identifies the specific reason for the denial and the plan provision on which the insurer is relying.
You may have the right to appeal.
Don't give up when your insurer fails to pay.
Remember, insurers sometimes delay, deny, or complicate reimbursement for out-of-network care, just as they do for in-network services.
Under federal claims-procedure rules applicable to many private health plans, insurers generally must decide post-service claims within 30 days, with a possible extension of up to 15 additional days under specified circumstances. Different rules may apply depending on your plan, including if you have TRICARE.
Know the deadlines that apply to your coverage, and don't hesitate to hold your insurer accountable.
If your insurance company fails to process a claim or refuses to provide a satisfactory explanation, consider filing a formal appeal. You may also be able to contact your state's insurance regulator, the U.S. Department of Labor, or another agency responsible for overseeing your particular plan.
For TRICARE beneficiaries, the appropriate regional contractor and TRICARE's appeals process are important starting points. If you encounter persistent administrative problems, contacting your congressional representative for constituent assistance may also be an option.
You are not being a nuisance or complaining unnecessarily when you insist that your insurance company honor the benefits you have paid for and are entitled to receive.
You are advocating for your own healthcare and, in the process, helping pressure a system to work better for everyone.
Accessing mental healthcare should not exacerbate the very problems that bring people into treatment. And the administrative burden of obtaining reimbursement should never become another reason for someone who needs help to go without it.
