What’s the Difference Between In-Network vs. Out-of-Network Providers for Therapy?
You’ve been looking for a therapist in SanDiego that takes your insurance and you keep hearing these two different terms “in-network” and “out-of-network.” What do they mean?
I’m here to break this down and help you better understand how you can utilize your insurance for your therapy.
Before I break down what each term means, I need to provide a brief explanation of the difference between an HMO and a PPO.
HMO vs. PPO vs. POS - How To Use Your Insurance for Therapy
Health Management Organizations (HMOs) offer a network of providers and hospitals that are all under the same umbrella and have a predictable cost for specific services (co-pays) such as primary care, specialty visits, mental health service, or labs and medications.
Examples of HMOs include: Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Kaiser Permanente, Sharp Health Plan, Scripps, UnitedHealthcare of California, etc.
Preferred Provider Organizations (PPOs) offer more flexibility in the type of provider that you can choose, hence the title "preferred provider." With a PPO plan, you have the choice of being seen by an in-network provider or expanding your options further by going out-of-network and seeking reimbursement for your out-of-pocket costs.
Point of Service Insurance Plans (POS) are similar to a PPO plan but are more of a hybrid between HMOs and PPO plans. These plans allow you the option of choosing whether you’d like to see a provider that’s either in-network OR out of network depending on your needs and preferences (hence the term “point” of service). This plan offers much more flexibility with regard to what type of provider you can see.
Examples of insurance companies that are PPOs are: Aetna, Anthem Blue Cross, Blue Cross Blue Shield, HealthNet, and United Health Care.
In-Network Providers for Mental Health
An in-network provider is a therapist who has specifically contracted with your insurance company. Insurance companies negotiate an approved rate that they pay directly to your therapist. You only have to pay your copay for each therapy session (less any deductible if applicable). If you have an HMO, you need to be seen by an in-network provider.
The best way to find out which therapists are in-network is by calling your insurance company and asking for a list of network providers. You can do this by calling the member services number on your insurance card. I am an in-network provider for Aetna.
Click here to learn more about how to find a therapist in San Diego that matches your specific needs.
Benefits of Utilizing In-Network Therapy
Lower Cost – In-network providers have pre-negotiated rates with insurance companies, meaning lower copays and out-of-pocket costs for you.
Predictable Expenses – With in-network therapy, you know exactly what your copay or deductible is, making it easier to budget for mental health care.
No Need for Reimbursement Paperwork – Since the provider is in-network, they bill your insurance directly, so you don’t have to worry about submitting claims yourself.
Familiarity with Insurance Policies – In-network therapists often understand the ins and outs of your insurance plan, making it easier to navigate treatment approvals.
Lower Risk of Denied Claims – Insurance is more likely to cover the treatment without unexpected denials or surprise bills.
Downsides of Utilizing In-Network Therapy
Limited Therapist Options – You may have a smaller selection of therapists, making it harder to find the right fit for your specific needs.
Long Waitlists – In-network providers often have higher demand, leading to longer wait times before starting therapy.
Insurance-Driven Treatment – Therapists may have to follow strict guidelines from insurance companies, which can limit the flexibility of treatment approaches. Insurance will only cover treatment that is considered “medically necessary” - meaning that you need to meet criteria for a mental health diagnosis which will become part of your medical record.
Session Limits & Coverage Restrictions – Insurance plans may cap the number of sessions or require a specific diagnosis for coverage, potentially cutting therapy short.
Less Privacy – Insurance companies require documentation of your diagnosis and treatment, which means your mental health records could be accessed by third parties.
Out-of-Network Providers for Psychotherapy
An out-of-network (ONN) provider is a therapist who has chosen not to participate with any particular insurance company so they can be freed up from the hassle of dealing with the red tape associated with the demands of insurance companies and have more freedom and flexibility to offer a more client-centered and tailored approach to your therapy.
ONN providers are able to provide you with a specialized receipt (called a “super bill”) that you can submit directly to your insurance for partial reimbursement of services depending on your plan coverage (less any copay, coinsurance and deductible).
Benefits of Seeing an Out-of-Network Therapist
More Freedom in Choosing Your Therapist – You’re not limited to providers within your insurance’s network, allowing you to find the best fit for your needs, and reducing long wait times to be seen.
Access to Specialized Treatment – Many specialists, such as EMDR therapists, trauma-focused providers, faith-based therapists, and in-person therapists, may not be in-network but offer highly effective care.
Greater Privacy & Confidentiality – Some clients prefer out-of-network therapy to reduce the amount of information shared with insurance companies.
More Personalized Care – Out-of-network therapists aren’t bound by insurance-driven limitations, allowing for more tailored treatment plans.
No Insurance Restrictions on Treatment Length – Some insurance plans can restrict the length of sessions based on medical necessity through routine outcome measuring and invasive monitoring of your progress which can potentially be questioned by quality care members who are unfamiliar with your specific case, whereas private pay allows therapy to continue as needed without insurance companies trying to dictate how long you should be in treatment, the type of treatment you should be receiving, or question the rationale for your therapy.
Downsides of Seeing an Out-of-Network Therapist
Higher Cost – Without the pre-negotiated rates from insurance, out-of-network therapy often has higher upfront costs.
Reimbursement Process Can Be a Hassle – Clients may need to submit claims, wait for reimbursement, and track paperwork, which can be time-consuming.
Not All Plans Cover Out-of-Network Therapy – Some insurance plans don’t offer out-of-network benefits, making it fully out-of-pocket.
Financial Accessibility – Higher costs may make consistent therapy less sustainable for some clients.
More Research Required – Clients must do more legwork to understand their benefits, confirm reimbursement rates, and find the best provider for their needs.
As an out-of-network provider I have partnered with Mentaya to make out-of-network therapy more accessible by helping you save money on your therapy and submit claims on your behalf for reimbursement. (*Please note that these are estimates and do not reflect the exact amount that you will be reimbursed until you receive your first reimbursement check.)
I hope this helps you better understand how you can apply your insurance benefits for therapy and find the right therapist in Chula Vista or San Diego, CA.
Ready To Get Started On Your Therapy in San Diego?
If you’re still feeling stuck or confused about the process, feel free to call me at (619) 494-0754 for a free, 15-minute phone consultation. Or click here to learn more. I’d be happy to learn more about what’s going on with you and see how I can help point you in the right direction.
Frequently Asked Questions
What types of therapy services do you offer?
I provide in-person therapy sessions at my office in Chula Vista, CA, as well as secure, online counseling for residents across California. Whether you're seeking support in person or from the comfort of your home, I’m here to meet you where you're at.
Do you specialize in trauma therapy?
Yes. I specialize in trauma-focused therapy, including support for PTSD, complex trauma, childhood trauma, and emotional abuse recovery, etc. I use evidence-based approaches to help you process and heal at your own pace.
What is EMDR therapy, and do you offer it?
EMDR (Eye Movement Desensitization and Reprocessing) is a powerful, research-backed therapy used to treat trauma and distressing life experiences. I’m trained in EMDR and use it to help clients reduce the emotional charge of past events and create new, more adaptive beliefs.
Do you offer Christian counseling?
Yes, I provide faith-based Christian counseling for clients who want to incorporate their spiritual beliefs into their healing journey. This approach is always personalized and client-led, respecting your unique values and worldview.
Can I work with you even if I’m not located in San Diego?
Absolutely! I offer online therapy throughout California via a secure telehealth platform. Whether you're in San Francisco, Los Angeles, Sacramento—or anywhere else in the state—I can support you virtually.
What’s your approach as a therapist?
I’m a Licensed Marriage and Family Therapist (LMFT) dedicated to helping individuals move from just getting by to living with purpose, clarity, and confidence. My work is trauma-informed, collaborative, compassionate, and rooted in respect for your lived experience.
How do I get started with therapy?
You can schedule a free 15-minute phone consultation by calling (619) 494-0754 or visiting my contact page. I’ll answer your questions, learn more about your needs, and help determine if we’re a good fit.
