Making Therapy More Accessible: Your Guide to Out-of-Network Insurance Benefits in New York
Finding the right therapist in New York City can feel overwhelming, especially when you're trying to navigate insurance coverage. If you're like most people, you probably started by looking for NYC therapists who accept your insurance – and that's completely understandable! I've been there too, and there's absolutely nothing wrong with that approach.
In-network therapists provide excellent care and can be a great fit for many people. However, if you've found yourself struggling to find therapists with availability in Manhattan, waiting months for appointments, or cycling through several providers without finding that crucial connection, you might want to explore another option: out-of-network benefits.
What Are Out-of-Network Benefits?
Out-of-network benefits allow you to see healthcare providers (including therapists) who don't have contracts with your insurance company. While you'll pay the full fee for sessions upfront, many insurance plans will reimburse you for a portion of the cost after you submit your paperwork.
This means there’s a higher upfront cost, but you eventually get a portion of your money back (and may be pleasantly surprised with how much they reimburse). As an out-of-network therapist in New York, I’ve seen clients with reimbursements for our sessions up to 90%! Granted, that doesn’t always happen. :) Most reimbursements tend to fall within the 30-80% range, which can still bring your session cost down pretty significantly and feel more within your budget.
Curious about your specific benefits? I'm happy to help you figure that out.
Why Some People Choose Out-of-Network Therapy
Let me be clear: there are many wonderful therapists who accept insurance. But here's the reality – when you limit yourself to only in-network providers, you might face some challenges:
Limited availability in NYC: In-network therapists in Manhattan often have full caseloads and long waiting lists. You may struggle to find someone with openings, let alone someone who feels like a good fit for what you’re looking for.
Fewer in-person options: With the high costs of office rent in Manhattan, there tend to be fewer insurance-based therapy options that offer in person appointments, especially in conveniently located areas.
Risk for burnout: Because insurance reimbursement rates are lower, insurance-based therapists need to see more clients to make a living. You may be one of 30 clients they’re seeing each week. I’ve personally had the experience of feeling like past insurance-based therapists I’ve worked with weren’t fully present in my sessions, which definitely dilutes the experience and impacts trust in the relationship.
The therapy shuffle: You might find yourself bouncing from therapist to therapist, trying to find someone available who's also the right fit. This can actually set back your mental health journey if you’re often needing to restart with someone else and feeling frustrated with the process.
Scheduling constraints: Insurance-based practices in New York often have less flexibility with scheduling and session frequency due to high demand.
The right fit matters: The therapeutic relationship is the most important factor in successful therapy. When you're not limited to your insurance network, you can choose based on specialties, approach, availability, and that intangible sense of connection.
One of my therapy offices on the Upper East Side of Manhattan, conveniently located near the 4/5/6 and Q trains and several bus lines.
Benefits of Working with Cash-Pay/Out-of-Network Therapists in NYC
Therapists in New York who work primarily with cash-pay or out-of-network clients often:
Maintain smaller caseloads, allowing them to be more present and less burned out during your sessions
Have more immediate availability to start when you're ready (especially important in a city where wait times can be months)
Can focus on clinical work rather than spending hours on insurance paperwork
Have convenient locations (like my offices on the Upper East Side and in NoMad/Midtown) or offer virtual sessions throughout New York State
May have specialties or niches that you’re interested in, such as people pleasing recovery or complicated grief, versus more generic “anxiety” and “depression” support
Again, this doesn't mean in-network therapists aren’t valuable and invested in your care – it's just a different business model that allows for different kinds of service.
Honest Challenges with Out-of-Network Benefits
There are some challenges that come with using out-of-network benefits (otherwise everyone would use them, right?). Here’s what to be mindful of to see if it’s the right fit for you.
Not everyone has OON benefits with their insurance: Some plans don’t offer any coverage or reimbursement for out-of-network providers, so you simply won’t have this as an option, unfortunately.
Higher upfront cost: If you do have OON benefits, you usually need to meet your out-of-network deductible before coverage kicks in, and then you will still pay the full amount for sessions upfront and wait to be reimbursed.
Potentially slow reimbursement: I wish there was a way to guarantee insurance would reimburse within a certain time frame, but honestly it will all depend on your insurance provider and their process/timing. In my experience, clients typically get reimbursed within 2-6 weeks, though it may be longer, especially in the beginning if you’re just starting with someone new and working towards your deductible.
Deductibles reset each year: Just like with any insurance (in or out of network), your deductible is going to reset each year. That means if you are seeing your therapist for an extended period of time, you will need to meet the deductible again once a new coverage year begins for insurance to continue reimbursing for sessions.
You still need a diagnosis on record: One reason some people don’t want to work with insurance is because they do not want any records documenting mental health diagnoses (often because of concerns about their employers accessing that info). Using your OON benefits will still require you to have a diagnosis for insurance to reimburse; the only way to truly avoid that is to pay for sessions completely out of pocket and not use insurance at all.
Which Insurance Plans Typically Have Out-of-Network Benefits?
Not all insurance plans offer out-of-network benefits, and the coverage varies significantly. Here's what you should know:
PPO Plans (Preferred Provider Organization): These plans typically offer the best out-of-network benefits. PPOs are designed to give you flexibility to see providers outside your network, though you'll pay more than if you stay in-network.
EPO Plans (Exclusive Provider Organization): These sometimes have limited out-of-network benefits, usually only for emergency care.
HMO Plans (Health Maintenance Organization): These rarely cover out-of-network care except in emergencies.
High-Deductible Health Plans (HDHP): These may have out-of-network benefits, but you'll need to meet your (usually high) deductible first.
New York State Health Insurance Plan (NYSHIP): If you're a New York State employee, teacher, or retiree, NYSHIP plans often have surprisingly good out-of-network mental health benefits with reasonable reimbursement rates.
I work with clients on insurance plans from providers including, but not limited to:
Aetna
BlueCross and BlueShield
Carelon Behavioral Health
Cigna
Evernorth
EmblemHealth
Empire Blue Cross Blue Shield
Government Employees Health Association (GEHA)
Group Health Incorporated (GHI)
Meritain Health
NYSHIP | NY State Empire Plan
Optum
Oxford
United Medical Resources (UMR)
UnitedHealthcare
UHC | UBHWellfleet
If you have a PPO plan or NYSHIP, you're most likely to have meaningful out-of-network mental health benefits. But regardless of your plan type, it's always worth calling to ask – insurance benefits can be surprising.
How to Check Your Out-of-Network Benefits
To get a sense of your benefits, check your plan documents or call the customer service number on your insurance card. Here's what to ask:
"Do I have out-of-network mental health benefits?"
"What's my annual out-of-network deductible for mental health services?"
"After I meet my deductible, what percentage does my plan cover for out-of-network therapy?"
"Is there a limit on the number of therapy sessions per year?"
“Does my plan cover telehealth?”
"Do I need a referral or pre-authorization for out-of-network mental health services?"
You are also welcome to reach out to me directly and I will run your insurance info to generate a custom estimate of your coverage details.
Understanding Your Benefits: A Real Example
Let's say your plan covers 60% of out-of-network therapy after a $1,500 deductible, and sessions cost $215 each:
Sessions 1-7: You pay the full $215 per session ($1,505 total) until you meet your $1,500 deductible
Session 8 and beyond: Insurance reimburses you 60% ($129 per session), leaving you with a cost of $86 per session.
Your actual benefits might be different – some people discover better coverage than expected, while others find their out-of-network benefits are minimal. The only way to know for sure is to call and ask.
The Reimbursement Process
Here's how the process actually works – I do my best to make it as straightforward as possible:
Payment at time of service - You pay the full session fee via credit card at each appointment
Detailed documentation - I provide you with a comprehensive receipt (called a superbill) that includes all the diagnostic codes and information your insurance needs
Submission assistance - I work with Thrizer, a platform that can help streamline the submission process to your insurance company, minimize your need to liaise back-and-forth with insurance, and provide cost estimates upfront (though this is optional if you’d rather just submit to your insurance on your own)
Reimbursement - Your insurance company processes your claim and sends reimbursement directly to you, typically within 2-6 weeks
Is it more work than just entering your insurance info once and paying a co-pay at the time of session? Yes. But for many people, the trade-offs are worth it to get to work with a provider of their choosing at a cost that feels more feasible than fully cash-pay therapy.
A simplified overview of the steps for insurance reimbursement. Feel free to reach out with any questions or to receive a personalized cost estimate for your insurance plan.
Getting Cost Estimates Upfront
One thing I can offer is clarity about potential costs before we start. Using Thrizer's calculator, I can provide an estimate of what your out-of-pocket costs and potential reimbursement might look like based on your specific plan. Keep in mind this is an estimate – we won’t know the exact amount you’ll be reimbursed until claims are processed – but it gives you a realistic picture to help with your decision.
Finding the Right Therapist in New York
Out-of-network therapy in NYC might be worth considering if you:
Have been searching for months without finding an available in-network therapist in Manhattan who feels like a good fit
Want to find a therapist with the ability to see you in person in convenient, well-appointed spaces on the Upper East Side or in NoMad/Midtown
Have worked with several in-network New York therapists but haven't felt that important connection
Value having more scheduling flexibility and personalized attention from your therapist
Have out-of-network benefits (especially with a PPO plan) that make the cost manageable for your budget
Prefer the option of virtual therapy sessions if you're anywhere in New York State
Virtual therapy can be a great option for those seeking increased flexibility for therapy sessions.
Making the Decision That's Right for You
Whether you choose in-network or out-of-network therapy, the most important thing is that you're taking steps to prioritize your mental health. Both options have their place, and what matters most is finding a therapist you connect with who can help you achieve your goals.
If you're curious about what out-of-network therapy might look like financially, reach out to request a personalized cost estimate. There's no pressure or obligation – sometimes just having the information helps you make the best decision for your situation. The bottom line is you deserve support, and there are multiple paths to getting it.
Hi, I’m Kim Jaso, LMHC!
I’m a licensed therapist in New York who specializes in working with anxious, people-pleasing millennial women navigating complicated grief, difficult family dynamics, life transitions, and relationship challenges. If you're considering out-of-network therapy, I'd be happy to provide a personalized cost estimate based on your specific insurance benefits and discuss whether this approach might be right for your mental health journey. Feel free to reach out – there's no pressure, just helpful information to guide your decision.