Understanding Insurance

Most insurance plans require you to pay for part of your care. This is called patient responsibility. To help you understand what this means for you, please review the descriptions below:

Deductible

Some plans include a deductible. This means you’ll need to pay a certain amount out of pocket before your insurance starts to cover your sessions. Deductibles usually reset each January.

Example: If your deductible is $500, and the allowed amount for your session is $130, you’ll pay $130 per session until you’ve reached your $500 deductible. Once that’s met, your insurance will begin paying according to your plan.

Copay

Once your deductible has been met (if you have one), some plans require a flat fee for each session.

Example: If your copay is $35, you’ll pay $35 at each visit, and your insurance will cover the rest.

Coinsurance

Instead of a flat copay, some plans require you to pay a percentage of the session cost after your deductible has been met.

Example: If your plan has 10% coinsurance and the allowed amount is $100, your insurance will pay $90, and you’ll pay $10.

Copay and Coinsurance Together

Some insurance plans require both a copay and coinsurance for each visit. In this case, you would pay your flat copay plus your percentage of the allowed amount.

Example: If your plan includes a $25 copay and 10% coinsurance on a $100 allowed amount, you would pay $25 + $10 = $35 for that visit.

Out-of-Network Benefits

If your therapist is not in your insurance company’s network, you may still have out-of-network benefits. These benefits allow you to get partial reimbursement from your insurance for sessions with an out-of-network provider.

Here’s how it usually works:

  • You pay your therapist’s full session fee at the time of service.

  • Your therapist gives you a superbill (a detailed receipt).

  • You send the superbill to your insurance company.

  • If your plan includes out-of-network benefits, your insurance may reimburse you for part of the session cost.

Keep in mind that out-of-network coverage often has:

  • A higher deductible than in-network services

  • A lower reimbursement rate (meaning you’ll be reimbursed for part, not all, of the cost)

Because every plan is different, it’s best to call your insurance company to ask:

  • Do I have out-of-network benefits for mental health therapy?

  • What is my out-of-network deductible?

  • What percentage of the session cost will be reimbursed?

  • How do I submit a claim for reimbursement?