Your Therapist Doesn't Take Insurance? How Out-of-Network Therapy Reimbursement Works in New York (People Go Out-of-Network 3.5x More Often for Mental Health)

You found a therapist you click with. Then you hear four words: "I don't take insurance." It can feel like the door just closed. It didn't. In New York, you may still get money back for therapy, even when your therapist is out of network. A 2025 study in Psychiatric Services found that people with private insurance go out of network 3.5 times more often for mental health care than for regular medical care (Psychiatric Services / RTI International, 2025). So this is normal. Most people just don't know how the money part works.

What "out of network" means

"Out of network" means your therapist has no contract with your insurance company. "In network" means they do have one. When a therapist is in network, the plan pays them directly. When a therapist is out of network, you usually pay them yourself. Then you ask your plan to pay you back. That pay-you-back step has a name: reimbursement.

Here is the part people miss. Out of network does not always mean no coverage. Plenty of plans still help with out-of-network care. How much they help depends on the kind of plan you have. We will walk through how to check that in a minute.

Why did your therapist leave insurance networks?

The main reason is money. Commercial insurers pay mental health clinicians less than they pay medical clinicians in the same plan. That gap is why so many therapists stop taking insurance.

It shows up most for the exact clinicians therapy clients see. The same RTI International data found people went out of network 10.6 times more often for psychologists, and 8.9 times more often for psychiatrists, than for medical clinicians (RTI International, 2024). So if a good therapist is hard to find in your network, that is not bad luck. It is the pattern.

A 2024 analysis by RTI International looked at claims for more than 22 million people. It found that commercial plans paid in-network medical and surgical visits about 22% more than behavioral health visits (RTI International, 2024). Same plan. Lower pay for the mental health side.

The gap gets sharper up close. RTI found insurers paid physician assistants 19% more than psychiatrists, and 23% more than psychologists, for similar visits (RTI International, 2024). When the pay runs that low, many therapists simply step out of the network.

They are far from rare. A 2024 study in Health Affairs Scholar reviewed 175,083 therapist profiles. It found that 35.1% of private-practice therapists take no insurance at all, and the average cash rate was $143.26 per session (Health Affairs Scholar, 2024). So if your therapist is out of network, you are in a very common spot. If you are still comparing options, this plain-language guide to finding a therapist who fits in New York can help.

What is a superbill?

A superbill is a detailed receipt from your therapist. It is the paper that makes reimbursement possible. Without it, your insurer usually will not process a claim.

A normal receipt just shows what you paid. A superbill shows much more. It lists the date of service, the therapist's license and tax ID, a diagnosis code, and a service code called a CPT code. A CPT code is a short number that tells the insurer what kind of visit you had. Your plan needs these codes to review the claim.

You do not make the superbill. Your therapist does. Most therapists will send you one each month if you ask. Then you send it to your insurance company. Some plans let you upload it online. Others want a paper form by mail, or an upload through an app.

One heads-up. A superbill has to include a mental health diagnosis. The claim will not go through without one. If that worries you, ask your therapist about it before you start. It is a fair thing to talk through.

How do out-of-network benefits work?

Your plan pays you back only after you meet your deductible, and only on the amount it decides is "allowed." Those two rules shape the whole check you get back.

Two plain terms first. Your deductible is the amount you pay yourself before the plan starts to help. Your coinsurance is the share the plan pays after that.

Here is the part that surprises people the most. The plan does not pay a share of your therapist's fee. It pays a share of its own "allowed amount." The allowed amount is the price the insurer decides a visit is worth. That number is often lower than what your therapist charges. So the money you get back may be smaller than you expected. It still helps, but plan for the gap.

Whether you get anything at all comes down to your plan type. This is step one, before anything else. Some plans include out-of-network benefits. Some do not. Here is how covered workers break down, per the KFF 2025 Employer Health Benefits Survey (KFF, 2025):

• PPO plans (46% of workers): usually include out-of-network benefits.
• POS plans (9%): often include some out-of-network benefits.
• HMO plans (12%): usually do not cover out-of-network care.
• HDHP/SO plans, the high-deductible type (33%): out-of-network help is limited or missing.

So almost half of workers have a PPO, which tends to help with out-of-network therapy. But a third are in high-deductible plans, where the help may be small or none. Check your own plan before you assume either way.

How do I check my out-of-network benefits?

Call the member number on the back of your insurance card. Ask a short list of questions. Write down every answer. This one phone call tells you almost everything you need to know.

Here is a simple script you can read out loud:

1. "Do I have out-of-network benefits for outpatient mental health?"
2. "Do I have an out-of-network deductible? How much of it have I met this year?"
3. "After my deductible, what percent do you pay for an out-of-network therapy visit?" (That percent is your coinsurance.)
4. "What is your allowed amount for CPT code 90837?" (That code means a 60-minute therapy session.)
5. "How do I send in a superbill, and what is the deadline?"
6. "Is there a yearly limit on visits or on dollars?"

Before you hang up, ask for a reference number for the call. Ask for the name of the person you spoke with too. If an answer turns out to be wrong later, that record helps you push back.

If the wait to reach a real person feels long, you are not alone. Many New Yorkers hit long waits, both for care and for straight answers. Our guide on long waitlists in New York covers what to do in the meantime.

How do I send in a superbill?

Once you know you have out-of-network benefits, the last step is simple. You send the superbill to your plan and wait for a decision. Keep a copy of everything you send.

Here is the usual path:

1. Ask your therapist for a superbill. Most send one each month.
2. Check that the codes and dates look right before you submit.
3. Send it the way your plan told you: online, by app, or by mail.
4. Save your confirmation and the date you sent it.
5. If you hear nothing in about 30 days, call and ask about the claim.

Most claims take a few weeks. Some get denied for small reasons, like a missing code or a typo. A denial is not the end. You can fix the error and send it again, and you can appeal if you disagree.

The Math, Worked (Hypothetical Plan — Check Yours)

Numbers below are a labeled hypothetical to show the mechanics — your plan's terms are the ones that matter, and the phone script below gets them.

Allowed amounts, deductibles, and co-insurance vary widely by plan. 90834 is the common CPT code for a 45-minute psychotherapy session; some sessions bill as 90837 (60-minute). No outcome or reimbursement is guaranteed — the phone call below is fifteen minutes and removes the guessing.

The Call That Answers Everything (Script Included)

Call the member-services number on the back of your insurance card and ask exactly this:

1. "Do I have out-of-network benefits for outpatient mental health — specifically CPT codes 90834 and 90837, via telehealth?"
2. "What is my out-of-network deductible, and how much of it have I met this year?"
3. "After the deductible, what percentage do you reimburse — and what is your allowed amount for 90834 in my area?"
4. "How do I submit a superbill, and how long does reimbursement take?"
5. "Is there a session limit per year, and do I need pre-authorization?"

Write the answers down with the date and the rep's name. That's the whole game — five questions, one call, and you know your real number.

Superbill to Reimbursement, Step by Step

1. Ask your therapist for a monthly superbill (here, it's automatic).
2. Confirm it shows: provider name + NPI, license, date(s) of service, CPT code, diagnosis code, fee paid.
3. Photograph or scan it.
4. Submit through your insurer's member portal (usually under "claims"), or by mail if they insist on paper.
5. Note the submission date; reimbursement typically arrives as a check or deposit with an EOB.
6. If denied: the EOB's denial code is the reason — call and ask them to explain it in plain language; many denials are clerical and fixable on resubmission.
7. Keep everything. A year of superbills is also documentation for HSA/FSA spending where eligible.

What are your rights as a New Yorker?

New York gives you real timing rights. A state rule called 11 NYCRR 38 says your plan must offer a first outpatient mental health appointment within 10 business days of your request (NY Dept. of Financial Services, 2025). That is the law, not a suggestion.

The same rule adds a second protection. If you leave a hospital, your plan must offer a follow-up mental health visit within 7 calendar days.

Now the part that can lower your cost. If your plan cannot give you a timely in-network therapist, it must let you see an out-of-network therapist at the in-network price (NY Dept. of Financial Services, 2025). In plain words: you get the out-of-network therapist, but you pay the lower in-network share. You have to ask for it. The plan will not usually offer it on its own.

This rule applies to commercial plans issued or renewed on or after July 1, 2025. By now, most plans in New York fall under it. If your plan keeps you waiting past the limits, call and use two words: "network adequacy." That is the exact standard the state holds insurers to.

Not sure whether you even need weekly therapy yet? That is a fair thing to sort out first, and this honest guide on whether you need therapy or are just stressed can help you decide. You do not have to figure all of this out alone before you begin. If you are in New York and want to talk through your options, you are welcome to reach out to book the call at matthewsextonlcswpllc.org.

Jul 2026: added worked reimbursement math, the insurer phone script, and the step-by-step checklist.