By Kristie Tse, LMHC-D (NY License #009672)
In network vs out of network therapy is one of the first practical questions I hear from people starting to look for a therapist in NYC, and it’s worth understanding clearly before you start, since it shapes both your cost and your options. Here’s what each actually means, how the money works, and how to think about which fits your situation.
What “In-Network” Means
An in-network therapist has a contract with your insurance company at a pre-negotiated rate. Your insurance covers a larger share of the session cost, and you typically pay a fixed copay or coinsurance, which makes budgeting more predictable. The tradeoff is a narrower pool of therapists to choose from (only those contracted with your specific plan), and sometimes limits on session frequency or approach set by the insurer rather than by you and your therapist.
What “Out-of-Network” Means
An out-of-network (OON) therapist doesn’t have a contract with your insurance company. You pay the full session fee upfront, then, if your plan includes out-of-network benefits, you can be reimbursed for a portion of that cost after submitting a claim. The upside is real: a much wider pool of therapists to choose from, no insurer-imposed limits on session frequency or treatment approach, and often faster access since you’re not limited to whichever in-network providers currently have openings. The tradeoff is the upfront cost and the reimbursement process itself.
What Is a Superbill?
If you use out-of-network benefits, you’ll hear this term constantly, and it’s rarely explained clearly. A superbill is an itemized receipt your therapist provides after each session, showing the date, the service provided, the diagnosis code, and the cost. You submit it to your insurance company as part of your reimbursement claim. Child Mind Institute’s guide to out-of-network benefits explains it clearly: the superbill shows your insurer exactly what care you received, and small errors on it, a misspelled name, a wrong birthdate, are the most common reason claims get rejected, so it’s worth double-checking the details rather than assuming it’ll go through automatically.
How Reimbursement Actually Works
This is the part that surprises people most. Your insurance company doesn’t reimburse you based on what you actually paid your therapist. It reimburses you based on what it considers the “allowable amount,” sometimes called the reasonable-and-customary rate, for that type of session in your area. If your therapist charges $180 for a session but your insurer’s allowable amount for that service is $130, your reimbursement is calculated off the $130, not the $180. Common out-of-network coinsurance rates run 50-80% of that allowable amount, after you’ve met your deductible for the year, not from the first session. So if your plan covers 70% and the allowable amount is $130, you’d be reimbursed $91 per session, regardless of what you were actually billed.
At Uncover Mental Health Counseling, we’re an out-of-network, private-pay practice: we don’t hold contracts with insurance companies, but we do submit the superbill and claim paperwork directly to your insurer on your behalf if you have out-of-network benefits, so you’re not left figuring out the process alone.
Making the Decision: What Actually Matters for You
Budget. If predictable, lower per-session cost matters most, in-network is usually the more manageable choice. If you can absorb the upfront cost and value flexibility, out-of-network opens up more options.
Therapist fit. In-network limits you to therapists contracted with your specific plan. Out-of-network lets you choose based on specialty, approach, or fit first, and figure out reimbursement second.
Privacy. In-network sessions are typically recorded in your insurance claims history. Out-of-network sessions paid directly aren’t submitted unless you choose to file a claim yourself, which offers more control over that record if privacy is a priority for you.
Administrative effort. In-network billing is usually handled directly between your therapist and insurer. Out-of-network requires submitting superbills and claims, work that a practice offering to handle that paperwork for you (as we do) can meaningfully reduce.
Speed of access. Waitlists for in-network therapists, especially specialized ones, can be long in NYC. Going out-of-network often means starting sooner.
Getting Support in NYC
If you’re still working out whether your plan even has out-of-network benefits, our guide to whether insurance covers therapy in NYC is a good place to start, and if cost is the main variable you’re weighing, our breakdown of what therapy actually costs in NYC goes into more detail. At Uncover, we’re happy to talk through your specific situation on a free consultation call, including helping you understand what your plan may reimburse before you commit to anything.
About the Author
Kristie Tse, LMHC-D, is the founder of Uncover Mental Health Counseling, a virtual private-pay therapy practice licensed across New York State. Her clinical background is in mental health counseling with a specialization in gender, sexuality, and identity development, and she works primarily with high-achieving adults navigating anxiety, relationship patterns, and identity, including Asian American and immigrant communities, LGBTQ+ individuals, and first-generation Americans. Kristie is fluent in English, Cantonese, and Mandarin, and her clinical writing and commentary have appeared in HuffPost, Verywell Mind, Well+Good, and Bustle.
FAQ: In-Network vs. Out-of-Network Therapy
What’s the difference between in-network and out-of-network therapy? In-network therapists have a contract with your insurer at a pre-set rate, so you pay a fixed copay. Out-of-network therapists don’t, so you pay the full fee upfront and can be reimbursed for a portion afterward if your plan includes out-of-network benefits.
What is a superbill? An itemized receipt your therapist gives you after each session, showing the date, service, diagnosis code, and cost, that you submit to your insurer as part of an out-of-network reimbursement claim.
How much will my insurance reimburse for out-of-network therapy? Typically 50-80% of your insurer’s “allowable amount” for that type of session, not 50-80% of what you actually paid, after your deductible has been met for the year.
Does insurance cover out-of-network therapy? It depends entirely on your specific plan. Some plans include out-of-network benefits, others don’t. It’s worth calling your insurer directly and asking specifically about out-of-network outpatient mental health benefits before starting.
Why would someone choose out-of-network over in-network therapy? Usually for more choice in finding the right therapist fit, fewer insurer-imposed limits on session frequency or approach, and often faster access, in exchange for more upfront cost and paperwork.
