Out-of-Network Therapy: How Does it Work?
By Ricardo Despradel, LMHC-D,LPC | Therapy for OCD & Eating Disorders in New York, New Jersey & Massachusetts
If you’ve ever searched for a therapist, you’ve probably run into a frustrating wall: the therapists who specialize in what you need often don’t take insurance. You find someone who looks like exactly the right fit and maybe they specialize in OCD, eating disorders, or trauma, but despite being the right fit, they are “out-of-network” with your insurance…so now what?
What Does “Out-of-Network” Mean?
Health insurance plans typically have a network of providers they’ve contracted with. When you see one of those providers, your insurance covers a portion of the cost — that’s “in-network.”
Out-of-network (OON) means the therapist hasn’t contracted with your insurance company. You pay the full session fee upfront, and depending on your plan, you may be able to submit a claim and get a portion reimbursed.
The Real Cost: Breaking It Down
Let’s say a therapy session costs $200–$300 out of pocket in NYC (a typical range for a licensed specialist). That sounds like a lot, but it doesn’t mean you actually pay that much.
Many out-of-network therapists provide a document called a “superbill” which is a detailed receipt you can submit to your insurance company for partial reimbursement. Depending on your plan, you could get 40–80% back after your deductible is met.
Out-of-network benefits vary widely. Before assuming you’ll get nothing back, call your insurance company and ask:
- Do I have out-of-network mental health benefits?
- What is my out-of-network deductible?
- What percentage do you reimburse after the deductible?
- Do I need a referral or prior authorization?
Some people are surprised to find their plan covers a significant portion of OON therapy.
HSA and FSA accounts: If you have a Health Savings Account or Flexible Spending Account, therapy sessions are typically an eligible expense. That means you’re paying with pre-tax dollars, which effectively reduces the cost.
When Out-of-Network Therapy Is Absolutely Worth It
For some conditions, the quality and specialization of your therapist is not optional. Unfortunately, even well intention therapist can cause more harm than good when treating a condition, they are not proficient at. It’s the difference between getting better and spinning your wheels for years.
OCD is a perfect example:The gold-standard treatment for OCD is Exposure and Response Prevention (ERP). But ERP is not something every therapist is trained in. In fact, many therapists inadvertently make OCD worse by using the wrong approach (like traditional talk therapy or reassurance-based techniques). Finding a therapist trained specifically in ERP, even if they’re out-of-network, is often the most cost-effective decision in the long run.
The same is true for eating disorders: Evidence-based treatments like CBT-E (Enhanced Cognitive Behavioral Therapy) and CBT-AR (for ARFID) require specific training and experience. A therapist without that background may not know how to address the cognitive distortions, food behaviors, and medical considerations involved in eating disorder recovery.
If your condition requires specialized treatment, settling for whoever takes your insurance, rather than whoever is actually trained to treat you can mean months or years of therapy that doesn’t move the needle.
Questions to Ask Before Committing to Any Therapist (In or Out of Network)
Regardless of insurance, here are a few questions worth asking before starting therapy:
1. What specific training do you have in treating [OCD / eating disorders / PTSD]?
1. What treatment approach do you use, and why?
1. How do you measure progress?
1. Do you provide superbills if I want to submit to insurance?
A good therapist will welcome these questions. The answers will tell you a lot.
The Bottom Line
Out-of-network therapy in NYC isn’t just about paying more, it’s often about accessing care that is actually designed for what you’re dealing with. For complex or specialized conditions, the right therapist is worth more than any copay savings.
That said, cost is real, and it matters. The best approach is to understand your benefits, ask about sliding scale options, and weigh the cost of not getting specialized treatment which often includes years of struggle, lost time, and missed quality of life.
Ricardo Despradel, LMHC-D, provides specialized telehealth therapy for OCD, eating disorders, ARFID, PTSD, and substance use disorders in New York, New Jersey, and Massachusetts. He offers evidence-based treatments including ERP, CBT-E, CBT-AR, and Prolonged Exposure, with affirming care for LGBTQIA+ and BIPOC individuals.
