Affording a Private Practice Therapist : How to Navigate Insurance, Superbills and Out of Network Benefits

One of the biggest barriers people face when seeking therapy is cost. Unfortunately, most health insurance plans still don’t cover mental health services as comprehensively as they do physical health care. This can make therapy feel out of reach—especially in larger cities where therapy rates tend to be higher. But with the right information, navigating the system becomes much more manageable. Here’s a breakdown of how to make therapy more affordable, even if your therapist is out of network.

1. Most Therapists Are “Out of Network” — What Does That Mean?

When a therapist is in-network, their services are directly covered by your insurance provider. In those cases, you're usually only responsible for a small co-pay per session. However, many therapists—particularly in urban areas—choose not to contract with insurance companies because reimbursement rates for mental health services are often too low to sustain a practice.

This means that most therapists are considered out of network, and insurance won’t cover their fees directly. But that doesn’t mean all hope is lost—this is where out-of-network benefits come in.

2. What Are Out-of-Network (OON) Benefits?

Out-of-network benefits allow you to get reimbursed for services from providers who are not directly contracted with your insurance plan. These benefits are typically offered through higher-tier plans, such as PPOs (Preferred Provider Organizations). Lower-tier plans—like HMOs (Health Maintenance Organizations) or EPOs (Exclusive Provider Organizations)—usually do not include this kind of coverage.

Not sure what plan you have? Check your insurance card or contact your insurance provider to ask whether your plan includes out-of-network coverage for mental health.

3. How Do Out-of-Network Benefits Work For Therapy?

The process is fairly straightforward:

• You pay the full cost of the therapy session upfront.

• Your therapist provides you with a superbill—an itemized receipt that includes necessary billing and diagnostic codes.

• You submit the superbill to your insurance company, usually through their online member portal.

• Your insurer reimburses you a percentage of the session cost.

When calling your insurance company, ask: “What are my out-of-network benefits for individual psychotherapy?” You can also provide CPT code 90834, which is the standard billing code for a 45-minute therapy session.

4. How Long Does Reimbursement Take?

Most insurance companies process claims within two to four weeks. Many insurers have digital portals that make the process simple: just upload your superbill, track the claim status online, and receive your reimbursement by check or direct deposit once it's approved.

5. How Much Will I Get Reimbursed?

Several factors determine how much you’ll get back:

a. Annual Deductible

This is the amount you must pay out of pocket before your insurance begins to reimburse you. Deductibles vary—some are as low as $500, while others can be several thousand dollars. Keep in mind that other medical expenses (like doctor visits or prescriptions) may count toward this deductible, so check to see what you've already paid this year.

b. Reimbursement Percentage

Once your deductible is met, your insurance will reimburse you for a percentage of the therapy session fee. This typically ranges from 50% to 90%, depending on your plan.

Example:Let’s say your therapist charges $250 per session, and your annual deductible is $1,000.

• You’ll pay the full rate for the first four sessions to meet your deductible.

• After that, if your reimbursement rate is 80%, your insurer will reimburse you $200 for each session.

• If you attend therapy weekly, your ongoing cost after the deductible would be around $200/month—a substantial savings over time.

Most deductibles reset at the beginning of each calendar year.

6. Will My Privacy Be Protected?

Yes. A superbill includes only the basics: your name, the therapist’s information, session dates, diagnosis codes, and billing codes. It does not include any session notes or personal details about what you discuss in therapy. This allows you to maintain privacy while still utilizing your benefits.

7. What If I Don’t Have Out-of-Network Benefits?

If your plan doesn’t offer OON coverage, there are still other ways to offset therapy costs:

• FSA/HSA Accounts: If your employer offers a Flexible Spending Account (FSA) or Health Savings Account (HSA), you can use pre-tax dollars to pay for therapy.

• Tax Deductions for the Self-Employed: If you’re self-employed, you may be able to deduct therapy expenses from your taxable income. Speak with an accountant to determine your eligibility.

Final Thoughts

The healthcare system can be complicated—especially when it comes to mental health coverage. But with some planning and persistence, therapy can become significantly more accessible and affordable.

If you’re considering therapy and feel unsure about how to navigate insurance reimbursement, feel free to reach out. I’m happy to help clarify the process and support you in getting the care you deserve.

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