Every October, open enrollment emails start showing up, asking you to review your benefits and choose your coverage for the year ahead. Most of them assume you're looking for providers who accept your insurance, but that isn't everyone's situation. You might already be paying out of pocket for therapy, or you may have found a therapist you really want to work with who doesn't participate with your insurance plan. When those emails start arriving, it's reasonable to wonder whether your insurance could help cover some of that cost.

If your plan has out-of-network mental health benefits, there may be a way to get some reimbursement even when your therapist is not in your insurance network. The amount depends on your specific plan, including your out-of-network deductible, coinsurance, and the amount your insurer considers allowable for the service.

How Out-of-Network Benefits and Superbills Work

When a therapist is out of network, you generally pay the therapist directly rather than having the insurance company pay the practice at an in-network rate. If your plan includes out-of-network benefits, the practice can provide documentation called a superbill that you can submit to your insurance company for possible reimbursement.

A superbill typically includes information your insurance company needs to process the claim, such as the provider's information, the date and type of service, the amount paid, and other claim information. Your insurance company then reviews the claim according to your specific benefits.

For example, imagine a therapy session costs $150. You pay the $150 to the practice, and the practice provides you with a superbill. If your insurance plan has out-of-network mental health benefits, you submit that superbill to the insurer. The insurer applies the claim according to your plan's deductible, allowed amount, and coinsurance, then reimburses you according to those benefits.

That does not necessarily mean you'll get a percentage of the $150 back. New York's Department of Financial Services notes that plans determine out-of-network reimbursement differently, and clients may be responsible for the difference between the provider's fee and the plan's allowed amount. Some plans also have a separate out-of-network deductible.

Before choosing your insurance plan for the coming year, it can be worth calling the member services number on your insurance card and asking:

• Does this plan include out-of-network outpatient mental health benefits?

• What is the out-of-network deductible?

• What percentage of the allowed amount is reimbursed after the deductible?

• How does the plan determine its allowed amount?

• Do I need to submit a superbill myself?

• Is there any additional documentation required?

If you're in New York, you can also ask your plan for an estimate of what it would reimburse for a specific out-of-network mental health service. Most New York-regulated health plans are required to provide an approximate reimbursement estimate when requested.

Why Some People Choose to Pay Privately

Out-of-network reimbursement can make therapy more affordable for some people, but insurance isn't the only factor people consider when choosing a therapist. Some clients decide to pay privately because they want to choose a therapist based on specialty, experience, and therapeutic approach rather than limiting their search to providers who participate with their insurance plan.

For someone working with a Cardinal Hope therapist around anxiety, relationship concerns, trauma, or a major life transition, that flexibility can be meaningful. You may be looking for a therapist who understands a very specific part of what you're going through, and the therapist who feels like the right fit may not happen to be in your insurance network.

There can also be a difference between paying privately and submitting claims for reimbursement. If you choose to submit a superbill to your insurance company, your insurer may require information such as a diagnosis or other claim details. Paying privately without submitting claims means you're choosing not to seek reimbursement through that insurance plan. Your individual circumstances and insurance policy matter, so it's worth asking questions before assuming either option will work a certain way.

Cost is also a completely reasonable thing to ask about before starting therapy. A first conversation is a chance to understand the session fee, ask whether the practice provides superbills, and figure out whether your insurance plan offers out-of-network benefits that could help with reimbursement.

Talk With Cardinal Hope About the Cost of Therapy

Cardinal Hope Mental Health Counseling Services is an out-of-network practice offering virtual therapy throughout New York and New Jersey. Our therapists work with adults navigating anxiety, relationship concerns, trauma, life transitions, and other challenges, and we're happy to talk through the practical questions before you get started. If you're considering therapy, schedule a consultation or contact our practice to ask about session fees, superbills, and what to look for when reviewing your out-of-network benefits. There's no need to feel awkward about asking about cost. It's an important part of deciding whether therapy is the right fit for you.