Helpful Questions to Ask:

  • Is the therapist I want to see In-Network (in my health insurance network)?
  • What is my deductible (what I have to pay before my insurance starts paying) for in-network mental health benefits?
  • How much is my co-payment (my cost-sharing portion of the bill) for mental health services?
  • Does my plan limit how many therapy sessions are allowed per year?
  • What is the policy year (i.e., Jan 1 – Dec 31)?
  • Does my policy cover 60-minute sessions? 
  • Does my policy cover telehealth (if this is a service you would prefer)?

If the therapist you want to see is not in your insurance network, you may want to find out if they are an “Out-Of-Network” provider for you. Some insurance companies will still allow you to see this therapist, but they may require you to pay a higher co-insurance/portion of the bill. In this case, you will want to ask:

  • Does my insurance company allow Out-Of-Network (OON) Mental Health Benefits?
  • If so, how much does my insurance pay for an OON provider? This is usually a percent (i.e., 70%). 
  • Does my OON payment count toward my deductible? If so, what is my OON deductible? Is it different than my in-network deductible?
  • Does my OON payment count toward my deductible?
  • Is approval required from my primary care physician (i.e., pre-authorization)? 

If you decide to see an Out-Of-Network therapist, you will be responsible for the portion of the bill the insurance company does not pay. The process works like this: you have a therapy session and pay for the session in full at the end of the session. Your therapist gives you a SuperBill as a receipt for your payment. You send the SuperBill to your insurance company and they reimburse you according to their Out-Of-Network rate. For example, if you have Out-Of-Network benefits at 70%, you will pay for 100% of the therapy session cost and get reimbursed 70% of that payment by your insurance company.

Note: Whether you use in-network or out-of-network benefits, any cost not covered by your insurance is your responsibility. 

Some people choose not to use insurance at all, using a direct pay option. In this case, you would pay for the session with HSA, cash, check or credit card. Your therapist may offer a reduced day-of-service rate.

Good Faith Estimate

If you are not enrolled in a plan or coverage or a Federal health care program (uninsured individuals), or are enrolled but not seeking to file a claim with your plan or coverage (self-pay individuals), you may request a good faith estimate of the expected charges you may be billed for.