Understanding insurance
Navigating insurance for therapy
Insurance for mental health care can be confusing. This page explains the most important concepts and what to actually say when you call your insurance company.
In-network vs. out-of-network
In-network
The provider has a contract with your insurance plan. You typically pay a copay per session (often $20–$50) and your insurance covers the rest after your deductible is met. This is usually the most affordable path.
Out-of-network (OON)
The provider does not have a contract with your plan. You pay the full session fee upfront, then submit a claim for partial reimbursement. OON benefits vary widely -- some plans reimburse 60–80%, others reimburse nothing.
Key terms to know
Deductible
The amount you pay out-of-pocket before insurance kicks in. If your deductible is $1,500 and you have not met it yet, you pay the full session fee until you reach $1,500 for the year.
Copay
A flat fee you pay per session, often after your deductible is met. For example: $30 per therapy session.
Coinsurance
Instead of a flat copay, you pay a percentage of the session fee. If your coinsurance is 20% and the session rate is $150, you pay $30.
Out-of-pocket maximum
The most you will pay in a year. Once you hit this number, insurance covers 100% for the rest of the year.
Superbill
A detailed receipt your therapist provides with billing codes (CPT codes) and diagnosis codes. You submit it to your insurance for OON reimbursement.
Mental Health Parity
Federal law (Mental Health Parity and Addiction Equity Act) requires that mental health benefits be covered at the same level as medical benefits. If your insurance covers unlimited physical therapy, they cannot arbitrarily cap mental health sessions.
How to use a superbill
- 1. Ask your therapist if they provide superbills (most private-pay therapists do).
- 2. After each session (or monthly), your therapist gives you the superbill.
- 3. Submit it through your insurance company's member portal or by mail.
- 4. Your insurance processes it and mails you a reimbursement check (or credits your account).
- 5. Timing: reimbursement typically takes 2–6 weeks.
EAP: Employee Assistance Programs
Many employers offer EAPs that provide 3–12 free therapy sessions per year at no cost to you, completely separate from your health insurance. EAP providers are often not in your insurance network, so this is a way to access therapy without using your deductible.
How to find yours: Check your employee handbook, ask HR, or call the benefits line listed on your pay stub or employer portal.
What to say when you call your insurance company
Call the member services number on the back of your insurance card. Ask:
- “What are my mental health benefits for outpatient therapy?”
- “What is my deductible, and how much of it have I met?”
- “What is my copay or coinsurance for in-network mental health visits?”
- “Do I have out-of-network mental health benefits? What is the reimbursement rate?”
- “Is there a limit on the number of sessions covered per year?”
- “Do I need a referral or prior authorization to start therapy?”
Write down the representative's name and the date and time of the call. Insurance companies sometimes give incorrect information verbally -- having a record protects you if there is a dispute.
When insurance is not an option: sliding scale
Many therapists offer sliding scale fees based on income -- meaning you pay what you can afford rather than a set rate. This is common in private practice and required at community mental health centers.
Do not be embarrassed to ask. A direct, honest request gets a direct answer: “I am uninsured / underinsured. Do you have sliding scale spots available? My budget is approximately $X per session.”