READ TIME : 3 min
The open enrollment emails start landing in October, and suddenly you’re supposed to understand deductibles, compare plans, and predict next year’s medical expenses.
A lot of the information assumes you’re looking for providers who take your insurance. But what if you already have a therapist you want to keep seeing, and you’re paying out of pocket?
Open enrollment can still matter. Here’s what’s worth checking before you click through the paperwork and hope for the best.
Paying out of pocket doesn’t always mean insurance can’t help
An out-of-network therapist doesn’t have a contract with your particular insurance plan. Some plans still offer benefits that may reimburse part of the cost of seeing that therapist. Others don’t cover routine out-of-network therapy.
That means “Do you take my insurance?” and “Could my insurance reimburse me?” are two different questions.
In my practice, clients pay me directly, and I can provide a superbill to submit for possible reimbursement. Coverage depends on your individual plan.
How out-of-network reimbursement works
A superbill is an itemized document with information about your appointments, provider, services, and applicable billing codes. You submit it according to your insurer’s claim process, and the insurer reviews whether the services qualify for payment. You may need to meet an out-of-network deductible before reimbursement begins. That can be separate from your in-network deductible.
Also, a reimbursement percentage may apply to the insurer’s “allowed amount,” rather than your therapist’s full fee. For example, if a session costs $250 and your plan reimburses 60% of an allowed amount of $150 after your deductible, reimbursement would be $90. Your remaining cost would be $160. This is an illustration, not a prediction of your benefits.
What to ask during open enrollment
Before choosing a plan, ask:
Does it cover outpatient, out-of-network mental health care?
What is the out-of-network deductible, and when does it reset?
What percentage is reimbursed, and how is the allowed amount determined?
Are referrals, prior authorization, or other coverage requirements involved?
How do I submit claims, and what are the deadlines?
If you attend online sessions, ask whether those visits are covered, too.
Compare the full picture: premiums, likely reimbursement, deductibles, and other healthcare needs. A plan with out-of-network benefits isn’t automatically the least expensive choice.
Why some people choose private pay
Some people choose a therapist because of their specialty, availability, or an established relationship they want to maintain. Others prefer to pay without submitting insurance claims.
When insurance isn’t being billed, its reimbursement requirements don’t determine whether a session is covered. That can leave more flexibility to plan care around clinical needs and personal goals.
That doesn’t mean private pay eliminates assessment, documentation, or clinical responsibility. And out-of-network reimbursement is still insurance use: claims generally require diagnosis and service codes, and plan requirements still apply.
I specialize in treating OCD, panic disorder, and anxiety. For clients working on any of these issues paying without submitting insurance claims may offer flexibility around working with a therapist who is trained specifically in treating these disorders.
Private pay isn’t the right financial choice for everyone. Using in-network care is a valid choice, too.
You can ask about cost right away
You don’t need to apologize, explain your finances, or wait until the end of a consultation to ask what therapy costs.
My fee is $250 for a 50 minute session. I’m an out-of-network provider offering in-person therapy in Syracuse and online therapy across New York.
Visit my contact page to request a free 15 minute introductory call. We can discuss fees, superbills, and what to clarify with your insurer before you decide whether to schedule.
Hi, I’m Michelle
I’ve been working in mental health since 2010 and struggling with anxiety for oh, idk, maybe my entire life.
And with my lived experience having anxiety, I know what works, what doesn’t, and what makes things feel worse. In here, you’re not alone, and I’ll work with you to shed the shame along with the anxiety. And by using evidence-based practices, I’ll help you recover, not just feel better.