Insurance
How to Use Out-of-Network Benefits for Therapy in New York
Tanya Fridland, LCSW (she/her)
· 5 min read
Many therapists in private practice, including me, are out-of-network providers. That doesn’t necessarily mean your insurance won’t help. Many plans include out-of-network benefits that reimburse part of the cost of therapy. Here’s how it works.
In-network vs. out-of-network
An in-network therapist has a contract with your insurance company and bills it directly. An out-of-network therapist doesn’t. Instead, you pay the therapist, and your insurer reimburses you for part of the cost according to your plan.
Out-of-network coverage is most common in PPO and POS plans. HMO and EPO plans often don’t include it. Your plan documents, or your insurer, can tell you which kind you have.
Terms you’ll see
- Deductible: the amount you pay out of pocket each year before your plan starts reimbursing. Out-of-network deductibles are often separate from in-network ones.
- Coinsurance: the percentage of the allowed amount your plan reimburses after the deductible is met.
- Allowed amount: the amount your plan considers reasonable for a service. Reimbursement is usually based on this, not on the therapist’s full fee.
- Superbill: a detailed receipt with the information your insurer needs to process a claim.
How reimbursement works with me
Before we begin, I can help you verify your out-of-network benefits, so you have a sense of what to expect. After sessions, I provide superbills. I also use Reimbursify, a service that helps submit superbills to your insurance company and streamlines reimbursement, so there’s less paperwork for you.
Reimbursement depends on your plan and isn’t guaranteed, which is why checking your benefits first is worthwhile.
Why some people choose out-of-network care
Out-of-network benefits can let you choose a therapist based on fit and specialty, rather than only on who’s in your plan’s network. For many people, finding the right person matters more than anything else in therapy.
If you have questions about your plan, bring them to a free consultation and we’ll go through them together.
This article is for general information and isn’t a substitute for individual care. A free consultation is the simplest way to see whether working together makes sense.