How to Use Your Out of Network Benefits to Pay for Therapy in Chicago

One of the most common reasons people don't reach out to a therapist they actually want to work with is cost. And I get it. $225 a session sounds like a lot. But if you have a PPO insurance plan, there is a good chance you are sitting on benefits you have never used that could significantly offset that cost.

Here is exactly how it works.

What does out of network mean?

Most therapists in private practice, especially those offering specialized or depth oriented work, are out of network providers. That means they do not bill your insurance directly. But that does not mean your insurance is useless.

If you have a PPO plan, you almost certainly have out of network benefits. That means your insurance will reimburse you for a portion of your therapy costs after you submit a claim. The amount varies by plan but it is often between 50% and 80% after your deductible is met.

How to find out what you are covered for

Call the member services number on the back of your insurance card and ask these specific questions:

Do I have out of network mental health benefits? What is my out of network deductible and how much of it have I met? What percentage of the allowed amount does my plan reimburse for outpatient mental health services? What is the allowed amount for a 45 or 50 minute psychotherapy session, CPT code 90834 or 90837?

Write everything down including the name of the person you spoke with and the date. Insurance companies are not always consistent and having a record matters.

What is a superbill?

A superbill is a detailed receipt that your therapist provides after each session. It includes your diagnosis code, the service code, the date of service, the fee you paid, and your therapist's credentials and license number. You submit this to your insurance company and they reimburse you directly.

I provide superbills to any patient who requests them. The process of submitting them is straightforward and most insurance companies allow you to do it online or by mail.

What does reimbursement actually look like?

Here is a realistic example. Say your plan reimburses 60% of the allowed amount after a $500 deductible. If the allowed amount for a session is $150, you would receive $90 back per session once your deductible is met. On a $225 session that brings your actual out of pocket cost down to $135.

Every plan is different so it is worth making that call to find out exactly what your numbers look like.

What if I don't have out of network benefits?

Some plans, particularly HMOs, do not have out of network benefits. If that is the case for you, therapy at $225 per session is a real investment. Here is how I think about it honestly.

Most of my patients come once a week. That is $900 a month. That is real money and I do not want to minimize it. What I will say is that the people who do this work tend to describe it as one of the most valuable things they have ever spent money on. Not because therapy is magic but because understanding yourself changes everything else. Your relationships, your work, your sense of what you actually want. That compounds over time in ways that are hard to put a number on.

But I also know that finances are real and I encourage anyone who is on the fence to make that insurance call first. You might be more covered than you think.

Ready to find out if we are a good fit?

I offer a free 15 minute consultation for anyone considering working together. We can talk about your goals, how I work, and whether this feels like the right fit. No pressure and no commitment.

If you are in Chicago or anywhere in Illinois and curious about telehealth psychodynamic therapy, I would love to hear from you.