Using Your Insurance for Therapy (Repost!)
One of the first questions people have when starting therapy is how to pay for it. Many consider using insurance, but the process can feel confusing. With a basic understanding of your plan, you can make a more informed decision, and potentially reduce your overall cost.
Below is a simple guide to how insurance works for therapy.
In-Network Therapists
When therapists say they “accept insurance,” they usually mean they are in-network with companies like Aetna, Cigna, or Blue Cross Blue Shield. In-network therapists have contracts with insurance companies and agree to set rates. With most plans, you’ll pay a copay, typically between $20–$65 per session. If you have a high deductible health plan (HDHP), you may need to meet your deductible before insurance begins covering sessions.
Pros:
Lower upfront cost
Simple payment (just your copay at each session)
Limitations:
Many therapists are at capacity or don’t accept insurance
Fewer available therapists, especially in cities like NYC
If you want to work with an in-network therapist, you would restrict yourself to a small portion of available therapists.
Out-of-Network Therapists
Out-of-network therapists (also called private pay) set their own rates and do not contract with insurance companies. In NYC, fees often range from $200–$350+ per session.
While this option has a higher upfront cost, it offers:
A wider selection of therapists
Greater access to specialists
Many insurance plans—especially PPOs—offer out-of-network benefits, which can reimburse a portion of the cost (often 50–80%) after you meet your deductible.
How it works:
You pay the full session fee upfront
Your therapist provides a receipt (called a “superbill”)
You submit it to your insurance for reimbursement
Like all professionals, therapists are weighing financial viability when they consider whether to be in-network or out-of-network. Many NYC therapists choose not to contract with insurance providers as the reimbursement rates are disproportionately low in NYC.
How to Determine Your Out-of-Network Benefits
Below is a step-by-step guide to determining if your plan offers out-of-network benefits and how much you would be reimbursed when seeing a therapist that is out-of-network.
Call the number on the back of your insurance card and ask the following questions:
Do I have out-of-network benefits for outpatient mental health services?
What is my out-of-network deductible? How much of this deductible have I met?
When does my deductible reset each year?
What is the coinsurance percentage for mental health services that my plan will cover? (This is the percentage that your insurance will cover once you meet your deductible.)
Is there a limit on the number of sessions that my plan will cover annually?
Do I need a referral or pre-authorization to receive services?
Are CPT codes 90791 and 90834 covered?
What is my out-of-pocket maximum?(This is the maximum amount you will pay in a plan year; once you exceed this amount, your insurance will pay 100% of all healthcare expenses. This amount resets each year.)
What is the “allowed amount” (UCR rate) for therapy sessions?
If they say the “allowed amount” is proprietary, try asking again. Explain that you need this rate in order to know how much you can expect to be reimbursed after satisfying your deductible.
How do I submit superbills for reimbursement? (Most insurance companies allow for invoices to be submitted via their website.)
A Few Things to Keep in Mind:
Deductibles vary widely
Out-of-network deductibles often range from $750–$3,000, but can be higher with HDHPs.
Timing matters
Deductibles typically reset on January 1. Starting therapy earlier in the year can help you make fuller use of your benefits once the deductible is met.
Reimbursement isn’t immediate
You’ll pay upfront and receive reimbursement later, depending on your plan.
If You Don’t Have Out-Of-Network Benefits
You still have a few options:
Work with an in-network therapist
Pay out of pocket for an out-of-network therapist
Ask about sliding scale rates (reduced fees based on financial need)
If your employer offers a plan with out-of-network benefits, consider switching to it during open enrollment (October or November)
Many people choose to pay out of pocket if they find a therapist who feels like a strong fit. Some therapists offer a limited number of sliding scale spots, so it’s always worth asking.