You can pay for out-of-network therapy in New York yourself or receive partial reimbursement from your insurer if your plan includes out-of-network benefits. How much you get back depends on your specific coverage.
You've found a therapist you'd like to work with, but then you discover they're not in your insurance network. Do you have to keep searching for someone who accepts your insurance, or could you still make therapy with this person work financially? Understanding your out-of-network payment options can help you figure out what's possible.
What Does It Mean if Your Therapist Is Out of Network?
An out-of-network therapist is someone who doesn't have a contract with your health insurance plan. Unlike in-network therapists, who agree to negotiated rates with insurers, out-of-network therapists generally set their own fees.
Choosing an out-of-network therapist gives you more flexibility to find someone who fits your needs. You can consider therapists whose experience and approach appeal to you, even if they aren't part of your insurance network.
Being out of network doesn't necessarily mean your insurance won't help pay for therapy. Some plans include out-of-network mental health benefits that reimburse part of the cost, while others don't offer this coverage.
Here's a snapshot of how in-network and out-of-network therapy compare.
| In-network therapist | Out-of-network therapist | |
|---|---|---|
| Contract with your plan | Yes | No |
| Session fee | A rate agreed with your insurer | The therapist’s own fee |
| What you pay at the session | Usually a copay or coinsurance | The full fee |
| Who deals with insurance | The therapist bills your plan | You send your plan a receipt, called a superbill |
| What your plan pays | Its share of the agreed rate | Part of the cost, if your plan has out-of-network benefits |
| Choice of therapist | Therapists in your plan’s network | Any therapist licensed in your state |
How Do You Pay for Out-of-Network Therapy?
If you're wondering how to pay for out-of-network therapy, you have a few options depending on your insurance benefits and financial situation. Here's how each option works so you can decide which makes the most sense for you:
Pay Privately
Under private pay, you cover the cost of therapy yourself without using your insurance benefits. You'll pay the therapist directly at each session, without having to submit insurance claims or wait for reimbursement.
Private pay is the most common way clients work with me. You pay $325 at the time of each session, including your first appointment, without going through your insurance company.
Get Reimbursed With a Superbill
If your insurance plan includes out-of-network benefits for therapy, your insurer may reimburse you for part of what you've paid after you submit a superbill. A superbill is a detailed receipt from your therapist that contains the information your insurer needs to process your claim, including:
Your name and identifying information
Your therapist's name, credentials, and billing information
The date and place of each therapy session
Diagnosis and procedure codes
The amount charged for each session
The reimbursement process works in a few steps. First, you pay for your therapy session and request a superbill from your therapist. Next, you submit it to your insurance company, usually through an online portal or claim form.
Afterward, your insurer reviews the claim and calculates any reimbursement based on your out-of-network deductible, allowed amount, and coinsurance. Finally, if you're eligible for reimbursement, your insurer sends the payment to you.
I provide superbills for out-of-network therapy sessions, which you can submit to your insurer. How much you receive back depends on your specific plan, so I recommend confirming your benefits before we begin.
How the Deductible, Allowed Amount and Coinsurance Change What You Get Back
Even if your insurance covers out-of-network therapy, you might not get back as much as you expect. How much you're reimbursed depends on your deductible, your insurer's allowed amount, and your coinsurance. Here's how each one works:
Out-Of-Network Deductible
Your deductible is the amount you must pay toward covered out-of-network services before your insurer generally starts reimbursing you.
For example, if your plan has a $1,000 out-of-network deductible, you'll need to meet that amount before your insurance starts contributing to eligible therapy costs. Keep in mind that insurers may count only their allowed amount toward your deductible, rather than the therapist's full fee.
Allowed amount
Your insurance company uses its own pricing rules to decide how much it recognizes as the cost of a therapy session. This price, known as the allowed amount, may be less than the full fee your therapist charges.
For example, even if a session costs $325, your insurer might recognize only $200 of that amount. It would then calculate your reimbursement based on $200, not $325.
Coinsurance
After you've met your deductible, coinsurance determines how you and your insurer share the cost of therapy. If your coinsurance is 20%, you pay 20% of the allowed amount, while your insurer pays the remaining 80%.
Say you have a plan with a 20% out-of-network coinsurance and an allowed amount of $200, your share would be $40. Your insurer would pay the remaining $160, assuming the session is covered. You would also be responsible for the $125 difference between the allowed amount and the therapist's $325 fee.
Example: Calculating Your Costs for a $325 Therapy Session
Let's use my $325 session fee to see how your costs might change before and after meeting your deductible. The table uses a hypothetical insurance plan with a $1,000 deductible, $250 allowed amount and 30% coinsurance, so your actual reimbursement may be different.
| Step | Before deductible is met | After deductible is met |
|---|---|---|
| Session fee | $325 | $325 |
| Allowed amount | $250 | $250 |
| Applied to deductible | $250 | $0 |
| Coinsurance (30%) | $0 | $75 |
| Insurer pays back | $0 | $175 |
| You pay | $325 | $150 |
Say it's your first session with me, and you haven't paid anything toward your $1,000 deductible yet. You pay $325, and your insurer counts the $250 allowed amount toward your deductible. This reduces your remaining deductible to $750, but you don't receive any reimbursement yet.
Once you've met your deductible after the fourth session, you still pay $325 for each session, but your insurer now covers 70% of the $250 allowed amount. Starting with your fifth session, you'll receive $175 back per session.
You'll pay the remaining $75, plus the $75 difference between the allowed amount and my session fee. Your final cost is $150 per session.
What to Ask Your Insurer Before Your First Session
Before starting out-of-network therapy in New York, it's worth calling your insurance company to check your benefits. Doing so will help you understand how much of your therapy costs you'll need to cover yourself and how much your insurer may reimburse. Here are seven questions to ask your insurer:
Do I have out-of-network outpatient mental health benefits?
What is my out-of-network deductible, and how much have I met?
What is my coinsurance?
What is the allowed amount for the session code?
Is telehealth covered out of network?
Are there session limits, or do I need pre-authorization?
How and where do I submit a superbill, and how long does it take?
Before ending the call, write down the representative's name, the date, and your call reference number. These details can be helpful if you need to follow up about your benefits or a reimbursement claim.
Frequently Asked Questions
Does a Therapist Have to Give Me a Superbill?
Superbills are something therapists choose to offer, and many out-of-network therapists provide one to help clients request insurance reimbursement. It's worth asking about this before your first appointment, especially if you plan to use your out-of-network benefits.
How Long Does It Take to Get Reimbursed for a Superbill?
The time it takes to receive reimbursement depends on your insurance plan and how you submit your claim. Some insurers process out-of-network claims quicker than others. Additionally, electronic claims may be processed faster than paper claims, while missing information can cause delays.
Under New York's prompt-payment law, insurers generally have 30 days to pay eligible electronic claims and 45 days for paper claims. However, these deadlines don't apply to every insurance plan, and processing may take longer if your insurer needs additional information.
Can I Use My HSA or FSA to Pay for Out-Of-Network Therapy?
You can generally use funds from a Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for out-of-network therapy if the treatment qualifies as a medical expense. According to the IRS, therapy for a diagnosed mental health condition qualifies, while services such as marriage counseling don't.
You don't pay federal income tax on money contributed to these accounts and used for eligible healthcare expenses, so paying for therapy this way can reduce your overall cost. Check with your HSA or FSA administrator to confirm whether your therapy sessions qualify and what documentation you'll need.
Starting Out-of-Network Therapy in New York
Being outside your insurance network doesn't necessarily mean therapy is beyond your budget. If you're considering out-of-network therapy in New York, you can pay privately or check whether your insurance benefits could help cover part of the cost.
I offer online therapy for postpartum and parenting challenges, adoption-related concerns, and anxiety, as well as adult autism evaluations and clinical hypnosis for anxiety. My practice is primarily private pay, and I provide superbills if you'd like to seek reimbursement through your out-of-network benefits. Schedule your first session and take the next step toward getting support, whether you're paying privately or using out-of-network benefits.
