There’s so much lingo around paying for therapy. Differentiating between “out-of-network” and “in-network” costs can be a huge headache.
If you’re looking for a new therapist, most of the time, you’ll find that providers charge anywhere from $100 to $200 for an hour-long session. But how much you actually have to pay out of pocket depends on a couple of factors. It’s usually more cost-effective to find a therapist that’s in-network with your insurance, but if you’re not able to do so, you might want to seek someone that takes out-of-network benefits. Generally, finding someone who’s out of network will still be cheaper than paying out of pocket with a therapist that doesn’t take any form of insurance.
However, there are some loopholes to be aware of. We break it all down so you don’t find yourself going down rabbit holes, with no end in sight.
First of all, what does out of network really mean?
When you go to therapy, you can pay a few ways.
If you pick a therapist that doesn’t accept insurance at all, you’ll pay their entire fee out of pocket. If your therapist takes your insurance plan, they’re in network and you pay a predetermined co-pay up front; your insurance pays the rest to your provider later.
If your therapist is out of network, it usually means that your insurer is “only willing to pay a certain amount toward your therapy with that person,” says Grace Dowd, a psychotherapist based in Austin, Texas. These plans usually cover less than they would an in-network provider.
The payment process for out-of-network therapy also works a bit differently. “When a therapist is out of network, they get paid right away, but the client ends up waiting to get paid back,” says Dowd. What does this mean? As a patient, you pay the full cost up front and wait to get reimbursed from insurance, so the provider gets paid quicker.
Any therapist or type of therapy can be out of network. Abby Gagerman, a therapist in Deerfield, Illinois, says in-network providers have to follow more insurance rules. If a provider is out of network, they might be able offer more individualized or niche care.
For example, Gagerman says an out-of-network therapist might accompany a client with agoraphobia to the grocery store, or be more willing than other providers to talk on the phone for 10 minutes during a client’s panic attack.
Okay, if I’m interested in seeing an out-of-network therapist, what do I do next?
If the provider you’re interested in is out of network with your insurance plan, definitely do some research beforehand so you know how much you’ll be paying.
Call up your insurer. Here are a few questions to ask before you commit to an out-of-network therapist:
- Whether you have out-of-network benefits
- The amount of your deductible, and if out-of-network services apply to it
- Your out-of-pocket limit (i.e., the maximum amount you can pay for out-of-network services)
How does payment work with an out-of-network provider?
Most of the time, you will pay the entire amount of a session up front. Gagerman says you can pay any way your out-of-network therapist will accept, whether that’s cash, a check or a health savings account. Many therapists even accept credit cards and direct payment platforms like Venmo and PayPal.
Your insurance plan will pay you back for their portion later. How you get reimbursed varies from therapist to therapist, so it’s a good idea to ask your clinician about their process ahead of your first appointment. If you don’t have money to pay out of pocket or you don’t want to rack up your credit card bill, this might make out-of-network therapists more difficult for you.
Sometimes, Dowd says, therapy offices (often group practices that have designated billing departments) will submit insurance claims on your behalf, and you’ll get a check in the mail later paying you back.
Other times, you’ll be in charge of getting your money back. If that’s the case, your therapist will give you a superbill — basically, a really detailed receipt — which you’ll submit to your insurance provider online or through the mail.
Then your insurance will pay you back for their portion after they process the claim. Each insurance provider is different, but it could take up to a few months to get paid back for out-of-network therapy. Ask your insurer about their policies for out-of-network reimbursement.
All these rules should apply if you see an out-of-network therapist via telehealth, according to Gagerman. At the start of the pandemic, both private insurance providers and Medicare authorized teletherapy, and they haven’t rescinded it yet. “I get paid for telehealth, whether you are in network or out of network,” she says.
What are some of the reasons patients seek out out-of-network providers?
It’s generally a lot cheaper to see a provider who accepts your insurance. But there are a few reasons you might see a therapist who’s out of network. First, Gagerman says, it’s often hard to find a therapist that’s accepting new patients. Many have long wait-lists due to the number of people seeking therapy right now, and if you’re in dire need of help with your mental health, an out-of-network provider might be available more quickly.
You might also find someone you like that specializes in something you’re struggling with or who meets other needs. For example, if you don’t want to drive 30 minutes to an appointment, a nearby therapist who practices a type of therapy you’re looking for might be worth paying the extra money.
Therapy is an investment in your mental health, but it’s up to you how much you want to invest. Either way: Do your homework up front so you don’t encounter any surprises.