By mid-November, you've probably seen your fair share of open enrollment emails.
Maybe you've already compared health insurance plans, selected your coverage for next year, or started looking more closely at what your benefits will actually include. Perhaps your premiums are increasing, your deductible is changing, or a provider you've been seeing won't be in your new network.
If you're already paying out of pocket for therapy, you might be wondering whether any of those changes affect you.
Before you start looking for a new therapist based solely on your insurance network, there's something worth considering: Your insurance coverage is one part of choosing a therapist. Finding someone who is the right fit for you is another.
What If the Therapist You Want to See Is Out of Network?
Insurance networks can be a helpful starting point when looking for a therapist, but they don't necessarily include every provider with the experience or specialization you're looking for.
Maybe you're working through difficult relationship patterns and want someone who specializes in relationship wounds and rebuilding self-trust. Maybe you're looking for a therapist with experience in ADHD in women. Or perhaps you've spent months building trust with your current therapist and don't particularly want to start over with someone new.
These things matter.
The therapeutic relationship is an important part of the work. Feeling comfortable enough to be honest, knowing your therapist understands your concerns, and having someone who is familiar with your history can make a meaningful difference in your experience of therapy.
Sometimes the therapist who is the best clinical fit for you isn't in your insurance network. That doesn't necessarily mean working together is out of reach.
What Are Out-of-Network Therapy Benefits?
Many health insurance plans offer what's called out-of-network benefits. These benefits may allow you to receive reimbursement for a portion of the cost of seeing a provider who doesn't participate in your insurance network.
Here's how it generally works:
You pay your therapist directly for each session.
Your therapist provides a document called a superbill.
You submit the superbill to your insurance company.
If your plan covers the service, your insurance reimburses you according to your out-of-network benefits.
Not every insurance plan includes out-of-network coverage, and reimbursement depends on your deductible, coinsurance, and the amount your insurance company considers allowable for the service.
If you've recently enrolled in a new plan, it's worth checking whether those benefits have changed for the coming year.
What Could Out-of-Network Therapy Actually Cost?
Let's use a real example.
My session rate at Tria Corda Counseling is $170. If your insurance plan includes out-of-network mental health benefits, you may be eligible to receive a portion of that fee back.
For example, imagine your plan reimburses 60% of its allowed amount for out-of-network therapy after you've met your deductible.
If your insurance company's allowed amount is $130, you could receive $78 back.
That would bring your effective session cost from $170 to $92.
These numbers are illustrative, not a guarantee of reimbursement. Your actual costs will depend on your individual plan, deductible, and coverage requirements.
The important thing to remember is that the amount you pay your therapist and the amount your insurance uses to calculate reimbursement aren't necessarily the same.
How Can You Check Your Out-of-Network Benefits?
You don't necessarily have to spend an afternoon navigating your insurance company's phone system to figure this out.
One resource I recommend is Thrizer, which helps clients verify their out-of-network benefits and navigate the reimbursement process.
I offer a Thrizer benefits verification link for prospective clients so you can get an estimate of what your insurance may cover before deciding whether to move forward.
Check Your Out-of-Network Benefits
Having this information upfront can make it much easier to understand what therapy might actually cost.
Should You Consider Private-Pay Therapy?
There's no universal answer. For some people, finding an in-network therapist is the best financial option. For others, the flexibility of private-pay therapy is worth considering.
Working with a private-pay therapist can offer more flexibility in treatment planning without having to structure your care around an insurance company's coverage requirements. If you choose to pay privately without submitting claims for reimbursement, your insurance company won't receive claims for those therapy sessions. For some people, that added privacy is an important consideration.
Most importantly, it gives you the freedom to consider therapists based on their experience, specialization, and whether you feel comfortable working with them.
You don't have to choose between taking care of your mental health and being thoughtful about your finances. Understanding your options can help you make a decision that works for both.
Let's Talk About What's Keeping You Stuck
If you've been considering therapy but aren't sure whether private pay is financially realistic, I'd encourage you to ask.
At Tria Corda Counseling, I work with women navigating relationship patterns, rebuilding self-trust, establishing healthier boundaries, and understanding how ADHD and emotional overwhelm affect their lives.
My current session rate is $170, and eligible clients may be able to receive partial reimbursement through their out-of-network benefits.
During a complimentary 15-minute consultation, we can talk about what you're looking for, whether my approach might be a good fit, and any questions you have about fees or insurance reimbursement.
You don't need to have everything figured out before reaching out.