Most people wait until a consult call to ask about money, then feel awkward raising it. You can get much clearer on the money question in about ten minutes, before you ever pick up the phone. Here is how therapy billing works in New York, how out-of-network reimbursement may work, and the questions that turn a vague fee into a number you can plan around.

In-network vs out-of-network

In-network means a therapist holds a contract with your insurance company. You usually pay a copay at each session, and the insurer settles the rest directly with the therapist.

Out-of-network means there is no contract. You pay the therapist their full fee, and then, if your plan includes out-of-network benefits, you submit for partial reimbursement afterward. Many experienced therapists in New York work out-of-network because it gives them more control over caseload size, session structure, and the administrative side of care. McGarril is an out-of-network practice, so the section below matters for getting part of your cost back.

What a superbill is, and what is on it

A superbill is the document that makes out-of-network reimbursement possible. It is an itemized receipt your therapist gives you, and you forward it to your insurer. A complete superbill includes the dates you were seen, the CPT code for each session (90837 for a standard 60-minute individual session, 90834 for 45 minutes, 90847 for family or couples sessions), a diagnosis code, the fee you paid, and your therapist's name, license type, and NPI number. Your insurer needs all of that to process a claim. We provide superbills you can submit for reimbursement.

How reimbursement works

The flow is straightforward once you have done it once. You pay for your sessions. You receive a superbill. You submit it to your insurer, usually through their member portal or app. Once you have met your annual out-of-network deductible, the insurer reimburses a percentage of what they call the "allowed amount" for each session.

A worked example, with the caveat that your plan controls every variable: say your deductible is met, your plan reimburses 70% of the allowed amount, and the allowed amount lands close to your session fee. A meaningful portion of each session then comes back to you. If the allowed amount is lower than the fee, or your deductible is high and unmet, you get back less, or nothing until the deductible clears. Your own numbers come from one phone call.

The ten-minute phone call

Call the member services line on the back of your insurance card and ask:

• Do I have out-of-network outpatient mental health benefits?

• What is my out-of-network deductible, and how much of it have I met this year?

• After the deductible, what percentage of the allowed amount do you reimburse for outpatient psychotherapy, code 90837?

• What is the allowed amount you use for that code?

• Is there a limit on sessions per year, and do I need pre-authorization?

• How do I submit a superbill, and how long does reimbursement take?

Write the answers down, get the representative's name, and ask for a reference number for the call. That record is worth keeping if a claim is ever questioned later.

Good Faith Estimate, HSA, and FSA

If you are uninsured or choosing to self-pay, you are entitled to a Good Faith Estimate, a written estimate of expected charges for your care. We provide one on request. Separately, therapy received as medical treatment is generally an eligible expense for HSA and FSA funds, so you can often pay with pre-tax dollars. Confirm the specifics with your plan administrator.

Common mistakes that cost people money

• Assuming "we don't take insurance" means no reimbursement is possible. With out-of-network benefits, it often is.

• Never checking out-of-network benefits, and paying the full fee when a plan would have reimbursed.

• Forgetting that the deductible resets every plan year.

• Collecting superbills and never submitting them.

FAQ

Do therapists in NYC take insurance?

Many do, and many also work out-of-network. If you have out-of-network benefits, you can still get part of the cost back.

What is a superbill?

An itemized receipt with the codes your insurer needs. You pay your therapist, then submit the superbill for reimbursement.

What does out-of-network mean?

Your therapist has no contract with your insurer. You pay directly and seek partial reimbursement afterward, depending on your plan.

What should I ask my insurance company?

Use the six questions above. The deductible, the reimbursement percentage, and the allowed amount are the three that set your real cost.

Can I use HSA or FSA funds?

Usually, since therapy as medical treatment is generally a qualifying expense. Confirm with your plan administrator.

For a fuller picture of fees and what you are paying for, read our post on the real cost of therapy in NYC. When you are ready to talk specifics, reach out and we will walk through cost and coverage with you.

Source: Good Faith Estimate requirements apply to uninsured and self-pay individuals under the federal No Surprises Act (cms.gov/nosurprises).