Going out-of-network is the fastest path to a full-fee, insurance-free private practice. This step-by-step guide walks through everything you need to set up as an OON provider — from getting your NPI to issuing your first superbill.
Step 1: Get Your Type 1 NPI
Your NPI (National Provider Identifier) is required on every superbill. Type 1 NPI is for individual providers. Apply at nppes.cms.hhs.gov — it is free and takes 1–2 weeks to process. You will need:
- Your full legal name and date of birth
- Your license number and state
- Your practice address
- Your Social Security Number (SSN) or EIN for the application
Step 2: Register Your Taxonomy Code
A taxonomy code identifies your professional specialty. Register the correct taxonomy code in NPPES when applying for or updating your NPI. Common mental health taxonomy codes:
- 101YA0400X — Licensed Professional Counselor (LPC)
- 1041C0700X — Licensed Clinical Social Worker (LCSW)
- 106H00000X — Marriage and Family Therapist (MFT)
- 103T00000X — Psychologist
- 103GC0700X — Clinical Neuropsychologist
Step 3: Get Your EIN (Optional but Recommended)
An Employer Identification Number (EIN) from the IRS can be used in place of your SSN on superbills and insurance forms. This protects your SSN from unnecessary disclosure. Apply free at irs.gov in minutes. Even solo practitioners without employees should consider getting an EIN.
Step 4: Set Your Fee
Your fee should reflect your expertise, market, and the value of accessible, high-quality care. Research what therapists with your license type and specialty charge in your city (Psychology Today's directory lists fees). Consider:
- Your target annual income and number of clinical hours per week
- Your overhead costs (rent, software, consultation, continuing education)
- A modest sliding scale allocation (typically 10–20% of caseload)
Step 5: Set Up Your Superbill Workflow
Every OON client needs a superbill after each session (or monthly). Superbilled lets you enter your provider details once and generate compliant PDF superbills in under 60 seconds. You can email them to clients directly from the platform. At $15/mo, it pays for itself after one client reimburses even a single session.
Step 6: Disclose OON Status at Intake
Include your OON status and superbill policy in your intake paperwork. Key points to communicate:
- You are not contracted with any insurance network
- Payment is due at the time of service
- You will provide a superbill that the client can submit to their insurer for OON reimbursement
- You cannot guarantee reimbursement — clients should verify their OON benefits
- A script for clients to call their insurer to verify OON mental health benefits
Step 7: Get Found — Referral Sources for OON Therapists
Without insurance panel listings, you need other ways for clients to find you:
- Psychology Today — The #1 therapist directory; $30/mo; essential for OON therapists
- Zencare — Curated directory; highly effective in coastal metros
- Alma — Offers billing support + referrals; they handle credentialing if you want some in-network clients
- TherapyDen — LGBTQ+ inclusive; strong for identity-affirming practices
- Personal website with SEO — Long-term traffic; worth building
Pros and Cons Summary
Pros of being OON:
- Full fee for every session — no insurance write-offs
- No credentialing paperwork or re-credentialing every 2 years
- No insurance-required treatment plans or utilization reviews
- Clinical freedom — see clients as long as clinically appropriate
Cons of being OON:
- Smaller addressable client pool (those with OON benefits or self-pay capacity)
- Clients must pay upfront and wait for reimbursement
- Requires clear upfront communication to set expectations