How Much Will Therapy Cost With My Out-of-Network Benefits?
If you’ve ever tried to figure out your out-of-network insurance benefits, it’s not exactly as straightforward as it should be.
Terms like deductible, coinsurance, allowed amount, and superbill can make answering a simple question difficult:
How much is therapy actually going to cost me?
If you’re considering working with an out-of-network therapist (hi, like me!), here’s what you need to know.
What does “out-of-network” mean?
An out-of-network therapist doesn’t bill your insurance company directly.
Instead, you pay the therapist’s full session fee. Depending on your insurance plan, you may then be able to submit your sessions to insurance and receive some of that money back.
How much you’re reimbursed depends on your particular plan.
The three numbers that matter most
When looking at your out-of-network mental health benefits, there are a few pieces of information that are especially helpful:
Your out-of-network deductible: The amount you need to pay toward eligible out-of-network care before your insurance begins reimbursing you.
Your coinsurance: The percentage of eligible costs your insurance covers once your deductible has been met.
The allowed amount: The amount your insurance company considers reimbursable for a particular service. This isn't always the same as your therapist's session fee.
Keep in mind: if your plan says it covers 60% of out-of-network therapy, that doesn't necessarily mean you'll receive 60% of your therapist's full fee.
What does this actually look like?
Here’s a fictional example.
Imagine your therapist charges $180 per session and you have $800 remaining on your out-of-network deductible.
You would initially pay the full $180 session fee while working toward that deductible. At that rate, it would take approximately five sessions to meet it.*
Afterward, let's say your insurance reimburses approximately $90 per session.
You would still pay your therapist $180 at the time of your appointment, but your insurance could send you approximately $90 back.
$180 session fee − $90 reimbursement = about $90 out of pocket
More of a visual person? I got you. Here’s an example:
*This is just an example. Deductibles, allowed amounts, reimbursement rates, and the way claims are processed vary by insurance plan.
How do I get reimbursed for out-of-network therapy?
Typically, your therapist provides something called a superbill. A superbill is essentially a detailed receipt containing the information your insurance company needs to process an out-of-network claim.
You submit that to your insurance company, and if the claim is eligible for reimbursement, your insurance company reimburses you directly.
Not sure what your benefits are? I can help.
You don't have to decipher all of this on your own.
If you're considering working with me, I can check your out-of-network benefits and send you a simple, personalized breakdown like the example above. You'll be able to see your deductible, estimated reimbursement, and approximately what therapy may cost you per session before deciding whether you'd like to move forward.
About Lauren
Lauren Lottino, LMFT, is a Colorado therapist specializing in grief, anxiety, trauma, sexual assault and abuse recovery. Her approach to therapy is warm, direct, and focused on helping clients create meaningful change in their lives.
