Why Out-Of-Network Benefits Can Be Better For Your Child’s Treatment

If you’ve been putting off calling because you assumed “out-of-network” meant “not covered,” you’re not the only parent who’s thought that. It’s one of the first questions almost every family asks, and it’s a fair one. Understanding your child’s mental health is stressful enough without also feeling like you need an insurance degree to figure out whether you can afford help. Here’s the short version: out-of-network doesn’t mean uncovered. It means the relationship between the practice and your insurance company works a little differently than it does at an in-network office. Once you understand how, most of the worry goes away. 

What “out-of-network” actually means 

When a provider is in-network, your insurance company has a contract with them. That contract sets the rate, dictates how many sessions are typically approved, and often shapes how treatment is structured, sometimes down to session length and frequency. 

When a provider is out-of-network, like our team, there’s no contract sitting between you and your child’s care. You pay for the session directly though the assistance of our partner Thrizer, and then, if your plan includes out-of-network mental health benefits (most PPO plans do), Thrizer helps you submit the claim. That one structural difference is also why so many families end up here in the first place. 

Why a practice chooses to be out-of-network 

This isn’t a workaround or a pricing decision made in isolation. It’s a clinical one. Being out-of-network means treatment decisions get made between our team and your family, not by what an insurance panel will approve. That means:  

• No artificial cap on session length or frequency 
• A treatment plan built around your child specifically, not a standardized protocol 
• No risk of care getting interrupted mid-treatment because authorization ran out 
• A truly individualized approach using CBT, ERP, and parent-involved models like 
• SPACE, chosen because they fit your child, not because they’re the only thing pre-approved 

For families who’ve been through the in-network system and hit a wall, three sessions approved here, a forced re-evaluation there, this is often the difference that actually gets a child unstuck. 

What it costs, in plain numbers 

Session rates for doctoral-level, evidence-based care typically run in the $250 to $325 range. We know that’s a real number, not a small one, and we’d rather say it plainly than have it be a surprise partway through a phone call. 

Here’s the part that changes the math for most families: with an out-of-network benefit, a large percentage of that comes back. Many families see 50 to 80 percent reimbursed per session, depending on their specific plan. Over a course of treatment, that’s the difference between “we can’t do this” and “this is manageable.” 

The other factor is length of treatment. Aspire Psychological Group’s goal is to get help people find solutions and not need therapy indefinitely. Even if you have a relatively small session copay of $50, over two or three years that can add up to more than you pay out-of-network for eight sessions.

How reimbursement actually works, and how our team helps 

The traditional process involves something called a superbill, an itemized receipt with the clinical codes your insurance company needs to process an out-of-network claim. Historically, families had to submit that themselves and wait. 

We’ve partnered with Thrizer to make that step easier. Instead of you tracking paperwork and submission deadlines on top of everything else, Thrizer helps facilitate the claims process directly, so you’re not stuck navigating it alone. For a lot of families, this is the piece that turns “I don’t have the bandwidth to deal with insurance right now” into a non-issue.

In-network vs. out-of-network at Aspire, side by side