Paying for Therapy: In-Network, Out-of-Network or Self-Pay

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Start with what matters most to you

You have decided to try therapy, and now the money question is in the way. People weigh the same few things: how predictable the cost is, how much choice they have in who they see, how much paperwork they can handle, and what information goes to their insurance company.

No option wins on every count. A person with a strong network and a tight budget may choose differently from someone who wants a specialist or prefers to keep therapy off insurance claims. Knowing which of those matters most to you makes the choice much simpler. These questions can help you sort it out:

• How much can I spend each month, and for how many months, if sessions continue for a while?
• Do I want a specific approach, such as DBT or trauma-focused care, that may be hard to find in my network?
• Would I mind my insurer receiving a diagnosis code for this care?
• Am I willing to submit claims and follow up on reimbursement every month?
• Do I have an HSA or FSA, and how much is in it?

In-network: your therapist bills your plan

An in-network therapist has a contract with your health plan. The therapist files the claim, and you usually pay a copay or coinsurance, often after meeting a deductible. Once you know your plan's terms, the cost per session is fairly predictable, and there is little paperwork for you.

The trade-off is choice. You pick from the plan's list, and the therapists with the training or openings you want may not be on it. Some plans also have rules such as prior authorization or reviews of whether continued care is needed. Every claim the therapist files goes to your insurer and usually includes a diagnosis code.

To find in-network options, start with your plan's online directory or the member services number on your card. Directories may not always be current, so it helps to confirm with the therapist's office that they are in your specific plan and accepting new clients.

Out-of-network with a superbill

An out-of-network therapist has no contract with your plan. You pay the full fee, and the therapist gives you a superbill, an itemized receipt you send to your insurer. If your plan has out-of-network mental health benefits, it may pay you back part of the cost once any out-of-network deductible is met. Mountainside works this way: it is out-of-network with all insurers, does not bill insurance directly, and provides superbills.

This route widens your choice, but the cost is the least predictable until you know your deductible, reimbursement rate and the amount your plan allows for each session. You also do the filing. The insurance and pricing page explains what a superbill contains and the exact questions to ask your plan, and affordable mental health treatment in Denver walks through the reimbursement math. Keep in mind that a superbill includes diagnosis codes, so submitting one shares that information with your insurer.

Self-pay without a claim

Some people with insurance choose not to use it for therapy. You pay the fee and never file a claim, so your insurer does not receive a diagnosis code or other details from that care. You also avoid plan rules about visit limits or reviews.

The cost is the full session fee, but you know it ahead of time. Federal rules also give uninsured and self-pay clients the right to a written Good Faith Estimate of expected charges when they schedule at least 3 business days ahead or ask for one. Our guide to the Good Faith Estimate for therapy explains what it lists and how ongoing sessions are estimated.

Paying with an HSA or FSA

A health savings account (HSA) or flexible spending arrangement (FSA) can lower the after-tax cost of any of the three options. IRS Publication 502 says you can include amounts you pay for psychiatric care, amounts you pay to a psychologist for medical care, and amounts you pay for therapy received as medical treatment as medical expenses.

IRS Publication 969 says HSA distributions are tax free when used for qualified medical expenses, and FSA reimbursements used for qualified medical expenses are not taxed. There is one catch: you cannot count the same dollars twice. If your insurer reimburses part of a session, only the part you paid yourself can come from these accounts. A few habits help:

• Keep every receipt or superbill, even if you never file an insurance claim.
• Check your plan's rules, since account administrators may ask for documentation.
• Track reimbursements so you do not pay the same expense from an HSA and get paid back by insurance.
• Ask a tax professional if you are unsure how a specific expense applies to you.

What a claim shares with your insurer

Privacy is a real factor for many people. Insurance claims and superbills usually include a diagnosis code. CMS notes that ICD-10 diagnosis codes, used for services since October 1, 2015, apply to all parties covered by HIPAA, not only to Medicare or Medicaid billing.

That does not make using insurance a bad choice. For many people the savings are worth it. The point is to choose knowingly: in-network billing and superbills both send a diagnosis to your plan, while self-pay without a claim does not. If you start self-pay and later decide to submit superbills, the diagnosis goes to your insurer at that point.

Choosing, and when cost should not wait

If predictable cost matters most, start by checking your network. If the therapist or approach matters most, look at your out-of-network benefits. If privacy matters most, self-pay may fit. Many people mix options, for example self-pay at first and superbills later, or a lower-cost skills group alongside individual sessions. Payment usually works the same way for video sessions as for office visits; see telehealth therapy in Colorado.

Cost questions are a normal part of a free consultation. If money is the main barrier, our Denver mental health resources page lists free and lower-cost options. And if you are in crisis, do not wait on any of this: call or text 988.

Frequently asked questions