What you describe is how I have experienced that out of network is done. You pay the therapist, and you submit paperwork to your insurance so they can reimburse you for the 50%. My insurance used to let me submit multiple claims at once for the same provider on one form. So that cut down on my paperwork. You could save them up and do a half dozen at a time. Then you get one big check. It's really not that bad once you get into the routine and develop a system for filling out the paperwork. Usually you can download the out of network claim form from your insurer's website.