Finding a Therapist in NYC? Here’s How to Understand Your Out-of-Network Mental Health Benefits

Let’s face it: trying to find a therapist in New York City can feel like dating—lots of options, lots of mismatches, and a lot of ghosting. But there’s one extra layer of confusion that can throw anyone off, especially when you're already stressed: understanding your out-of-network benefits.

If you’ve ever found a therapist you really like, only to hear, “Sorry, I don’t take insurance—but I can give you a superbill,” and then felt completely lost…this post is for you.

Let’s break it down in plain English—no insurance jargon, no medical speak. Just what you need to know to get help and get reimbursed.

What Does “Out-of-Network” Mean?

When a therapist is “out of network” (OON), it means they don’t have a contract with your insurance company. You’ll pay them directly, then you might get some of that money back—if your insurance plan covers out-of-network behavioral health.

You might pay $200–$350+ per session upfront, but if your benefits cover it, you could get 30–80% reimbursed after your deductible is met.

Do You Have Out-of-Network Benefits?

It depends on your insurance plan, not just your insurance company. Even within the same company (like Aetna, Cigna, Blue Cross), different plans offer very different mental health coverage.

Here’s how to check:

1. Call the number on your insurance card or log in to your member portal.

2. Ask:

   • Do I have out-of-network coverage for behavioral health or psychotherapy?

   • What’s my out-of-network deductible? Has any of it been met?

   • What percentage do you reimburse after I meet the deductible?

   • Do you need a diagnosis code (hint: usually yes)?

   • What form do I use to submit claims?

You can also ask: Do you reimburse CPT codes 90791, 90834, or 90847? (These are billing codes for an initial evaluation, 45-minute individual therapy session, and 60-minute couples/family therapy session respectively.)

What You Might Pay—and Get Back

Here’s an example for someone in NYC:

• Your therapist charges: $300 per 45-minute session

• Your deductible (what you pay before insurance kicks in): $1,000

• Your coinsurance after deductible is met: 70% reimbursed

👉 If you’ve met your deductible, your insurance would reimburse $140 per session. You’re left paying $60 out-of-pocket.

👉 If you haven’t met your deductible, you pay the full $200 until you reach $1,000 in total payments.

Keep track of those receipts—once you hit that deductible, your reimbursement starts.

What’s a Superbill, and What Do I Do With It?

A superbill is basically a detailed invoice from your therapist that includes:

• The date and length of your session

• A diagnosis code (required for insurance reimbursement)

• The billing code (CPT code)

• The provider’s info and license number

• What you paid

You submit this to your insurance (via their app, portal, or mail), and they reimburse you directly.

Why Is This Especially Important in NYC?

In New York City, a huge number of therapists are private pay only. This is partly because:

• Insurance pays them far less than their standard rates

• It can be a hassle to deal with insurance companies

• Demand is high, and many clinicians have full caseloads

So, if you want options and more flexibility, understanding your out-of-network benefits opens up a lot more doors.

NYC Tips: Getting the Most From Your Benefits

• Use Health Savings Accounts (HSA) or FSA: Therapy is an eligible expense

• Negotiate session rates: Some therapists offer sliding scale if you’re paying out of pocket

• Ask about package discounts: Some clinicians offer slightly lower rates if you commit to weekly sessions

• Consider group therapy: More affordable, still highly effective, and also reimbursable in many cases

  
  

Final Thoughts: You Deserve Support—and Clarity

Mental health care in NYC is more accessible than it seems—but the system makes it hard to understand. If you’re feeling overwhelmed by the idea of “out-of-network,” that’s totally normal. You’re not doing it wrong.

Getting reimbursed may take a few extra steps at first, but once you understand your benefits, it becomes a powerful way to access care that truly fits you.

Because in a city this loud, fast, and intense—you deserve a space that helps you feel seen, grounded, and supported. At City Lights Psychology, we always step in if there is an issue with reimbursement. We will get it resolved for you. We understand the difficulty in dealing wtih insurance companies and we are here to help.