If you’ve ever called a psychiatry office, heard “we’re out-of-network,” and immediately thought, Okay… so I can’t afford this — you’re not alone.
We get this question every week, and it’s a fair one. When you’re looking for help, the last thing you want is a confusing billing situation.
This post explains why we’re out-of-network, what that actually means for you, and how many patients use out-of-network benefits to reduce their cost — without needing a finance degree to understand it.
Key Reasons Our Practice Is Out-of-Network
This is one of the most common questions we get, and we understand why. When you’re looking for help, the last thing you want is another confusing barrier.
So here’s the honest answer: we are out-of-network because it allows us to protect the kind of care we believe patients deserve — and it allows us to run a stable practice that can keep serving patients over time.
1) The first (and most important) reason is patient care
Insurance companies don’t just “pay for care.” They often shape it.
Here are a few ways that can impact patients in real life:
Insurance can limit the care you’re allowed to receive.
Depending on the plan, insurers may restrict the number of visits, dictate what type of service they consider “medically necessary,” and sometimes even influence how frequently you can be seen. In some settings, that pushes care into shorter, more rigid visit structures.
The system often rewards symptom control over true long-term improvement.
Many insurance models are designed around brief, problem-focused encounters. That can unintentionally encourage a “quick fix” approach rather than investing the time needed to understand the whole picture — what’s driving symptoms, what’s maintaining them, and what supports lasting change.
Prior authorizations delay care and create unnecessary friction.
Insurance companies may require prior authorization for medications, certain treatments, and sometimes even the initial evaluation process. It can mean paperwork, phone calls, delays, and patients waiting longer than they should — often when they’re already struggling.
It can limit clinical flexibility and individualized decision-making.
People aren’t templates. Some patients need more time up front, more careful diagnostic work, or closer follow-up early in treatment. We want the ability to recommend what clinically makes sense — not what a billing system makes easiest.
2) The second reason is the reality of running a practice that can stay available
This part is not glamorous, but it matters. A practice can’t provide great care if it’s constantly fighting to stay afloat.
Insurance reimbursement rates are often far below the true cost of providing care.
When reimbursement is low and overhead is high (staff, rent, technology, compliance, benefits, etc.), small practices get squeezed. Over time, that can lead to reduced availability, reduced support staff, and clinicians burning out — which ultimately affects patient experience.
Negotiating with insurance companies is extremely time-consuming and rarely successful for small practices.
Large systems have whole departments for this. Small practices don’t. That time has to come from somewhere — and it usually comes from patient care.
The administrative burden is significant.
Claims issues, documentation requirements, phone calls, appeals, and follow-up can consume hours every week. We believe those hours are better spent doing what patients actually need: evaluations, follow-ups, coordination, and thoughtful care.
Payment delays can create major cash-flow problems.
Insurance companies can take weeks (and sometimes longer) to process claims and reimburse. That instability makes it harder to invest in staffing and systems that improve patient support and responsiveness.
What “Out-of-Network” Means
Out-of-network simply means: we don’t have a contract with your insurance company.
So instead of your insurance paying us directly at a pre-negotiated rate, you pay the practice, and then (depending on your plan) your insurance may reimburse you.
A few important notes:
- Out-of-network is not the same as “not covered.” Some people have great out-of-network benefits. Others have none.
- Reimbursement is usually based on your plan’s allowed amount (what the insurer thinks a service should cost), not necessarily what a clinician charges.
- Many PPO plans include out-of-network benefits; many HMO-style plans do not. But there are exceptions, so it’s worth checking.
The 5 Questions to Ask Your Insurance
If you want clarity quickly, these are the five questions that make the biggest difference. You can ask them by phone, through your insurance portal, or through a benefits-check tool if your plan has one.
1. Do I have out-of-network benefits for outpatient mental health?
(Use the words “outpatient mental health” and “out-of-network.”)
2. What is my out-of-network deductible, and have I met it?
Some plans have a separate deductible for out-of-network services.
3. After my deductible is met, what is my out-of-network coinsurance?
Example: “Do you reimburse 60%?” “Do I pay 40%?” (They’ll often state it this way.)
4. What is the allowed amount for psychiatric evaluation and follow-up visits?
If they can’t give an exact number, ask if there’s a tool or department that can.
5. Does my plan reimburse for telehealth out-of-network?
Coverage rules for telehealth can vary more than people expect.
If you get answers to those five questions, you’ll have a much clearer sense of whether out-of-network care is workable for you.
A Simple Reimbursement Example
Let’s use easy numbers, just to make the concept concrete.
Imagine:
- Your visit cost is $300
- Your insurance plan’s allowed amount for that visit is $200
- Your out-of-network coinsurance (after deductible) is 60%
In that scenario, your insurance might reimburse:
60% of $200 = $120
So your net cost would be:
$300 – $120 = $180
That’s why you’ll sometimes hear people say, “I got reimbursed, but not for the full amount.”
And it’s also why two patients with “the same insurance company” can have totally different experiences — because the details of the plan matter.
How We Try to Make Out-of-Network Easier
We know the insurance side can feel overwhelming—especially when you’re already dealing with stress, symptoms, or a packed schedule. While we can’t control your plan’s rules, we can make the process clearer and reduce the admin burden where possible.
Here are two tools we use to help:
- Mentaya (benefits + reimbursement estimate):
Mentaya can help you get a clearer sense of whether your plan has out-of-network mental health benefits and what reimbursement might look like. It’s not a guarantee (insurance is insurance), but it often gives patients a helpful starting estimate before they commit to care. - Thrizer (out-of-network claims support + cost reduction when eligible):
Thrizer is a service that can help with the out-of-network reimbursement process and, for some patients when eligible, may reduce the hassle of submitting claims and make the cost feel closer to an “in-network-like” experience. Eligibility depends on your specific plan and benefits (and often whether your deductible has been met).
We’ll point you to the right next step based on your plan and what you’re looking for.
Conclusion and Practical Steps
We chose to remain out-of-network because we believe it’s the best way to protect the quality of care we provide.
By stepping away from the constraints that often come with insurance contracts, we’re able to offer care that is more personalized, more flexible, and more clinically thoughtful—with enough time and support to focus on what’s actually driving symptoms and how to create lasting improvement.
Just as importantly, this model helps us maintain a practice that is stable and sustainable—so we can continue to be available to current and future patients, invest in excellent staff and systems, and provide the level of responsiveness and attention that people deserve when they’re seeking help.
If you’re considering working with us, here are a few practical ways to move forward:
Check your out-of-network benefits (quickest clarity).
Ask your insurance the five questions listed above: out-of-network mental health coverage, deductible, coinsurance, allowed amounts, and telehealth coverage.
Visit out Fee page and use our Mentaya tool to get an estimate (when available for your plan).
This can help you understand potential reimbursement before you start.
Ask us about Thrizer if you want help with the out-of-network process.
For some patients (depending on plan eligibility), Thrizer can make reimbursement less of a headache and sometimes reduce the “sticker shock” feeling of out-of-network care.
Call our office if you want help understanding the process.
We can explain our fees, walk you through the reimbursement steps, and help you figure out the most realistic path forward.
Don’t let “out-of-network” be an automatic no.
For some people, it isn’t financially feasible—and we respect that. But for many, out-of-network benefits can make care more affordable than expected, especially if they have a PPO plan.
Note: This article is for educational purposes and isn’t insurance or legal advice. Coverage and reimbursement vary by plan and can change over time.
