Health insurance can make therapy far more affordable, but the vocabulary can feel like a second language. Words like “in-network,” “coinsurance,” and “allowed amount” decide what you actually pay, and plans differ widely. A short call to your insurer before your first session usually answers most of the questions.
This guide walks through the terms, the questions to ask, the federal rules that protect mental health coverage, and the options available when the provider you want does not bill insurance. Your plan documents and your insurer remain the authority on your own benefits.
In-network or out-of-network
An in-network provider has a contract with your insurance company. They bill the insurer directly, accept the plan’s negotiated rate, and you pay your share. An out-of-network provider has no contract with your plan. You typically pay the full fee at the time of service and then, if your plan includes out-of-network benefits, submit a claim to be partly reimbursed.
PPO plans generally let you see out-of-network providers at a higher cost, while HMO and EPO plans generally do not cover out-of-network care except in an emergency. Your plan type is often printed on your insurance card, and it is the first thing to check.
The four numbers that decide what you pay
Deductible
The amount you pay for covered care each plan year before the plan starts paying. Many plans have separate in-network and out-of-network deductibles.
Copay
A fixed dollar amount you pay per session, such as $30, often after the deductible is met, depending on the plan.
Coinsurance
A percentage of the cost you share, such as 20 percent, after the deductible is met. For out-of-network care, it is usually a percentage of the plan’s allowed amount rather than the provider’s fee.
Out-of-pocket maximum
The most you pay for covered services in a plan year. Once you reach it, the plan pays for covered in-network care for the rest of that year.
Questions worth asking your plan
- “Do I have in-network and out-of-network outpatient mental health benefits?”
- “What is my deductible for each, and how much have I met this year?”
- “What is my copay or coinsurance for a 53-minute or longer session, CPT code 90837?”
- “For out-of-network care, what is the allowed amount for 90837 in my ZIP code?”
- “Do I need pre-authorization or a referral for outpatient therapy?”
- “Is telehealth covered the same way as in-person sessions?”
Write down the date, the representative’s name, and a reference number for the call. If you are considering couples or family therapy, ask about that specifically, since coverage rules for it can differ.
Out-of-network reimbursement and superbills
If you see an out-of-network provider, you can usually ask for a superbill — an itemized receipt with the codes your insurer needs to process a claim. You submit it through your plan’s member portal or a claim form, and the plan reimburses you according to your out-of-network benefits. Like any insurance claim, it includes a diagnosis code. Our step-by-step superbill guide covers exactly what a superbill must contain and how to file it.
Your rights: parity and the No Surprises Act
The federal Mental Health Parity and Addiction Equity Act (MHPAEA) requires that when most health plans cover mental health and substance use care, the financial requirements and treatment limits are comparable to those for medical and surgical care. According to the U.S. Department of Labor, that means copays and deductibles need to be similar, and visit limits, prior authorization requirements, and medical-necessity reviews need to be comparable. All plans sold on the Health Insurance Marketplace cover mental health and substance use services as essential health benefits.
In September 2024 the Departments of Labor, Health and Human Services, and the Treasury issued a final rule strengthening parity requirements. On May 15, 2025, the Departments announced they would not enforce the new requirements of that 2024 rule while they reconsider it, during related litigation and for 18 months after a final decision.
The same statement confirms that the parity statute and the earlier 2013 parity regulations remain in effect. If a mental health claim is denied, you can appeal, and your state insurance department can take complaints.
If you are paying privately, the No Surprises Act gives you a right to a Good Faith Estimate of expected charges. According to the Centers for Medicare & Medicaid Services, providers generally must give one to people who do not have or are not using insurance when care is scheduled at least three business days ahead, or on request. If the final bill is at least $400 more than the estimate, you may be able to dispute it.
HSAs, FSAs, and private-pay specialists
Health Savings Accounts and health Flexible Spending Arrangements can be used for qualified medical expenses. IRS Publication 502 lists amounts paid for psychiatric care, to a psychologist for medical care, and for therapy received as medical treatment among includible medical expenses. Your plan administrator can confirm what documentation they need.
Some specialists choose not to join insurance networks. Practices give a range of reasons, including the administrative time that billing requires, the session lengths or formats their work involves, and clients who prefer that no diagnosis be shared with an insurer. Many of these providers offer superbills for out-of-network reimbursement, and some offer sliding-scale fees. Asking a provider directly how they bill is always welcome.
- In-network providers bill your plan directly; out-of-network care is reimbursed only if your plan has out-of-network benefits.
- Your deductible, copay or coinsurance, and out-of-pocket maximum decide what you pay.
- Call your plan before your first session and ask about CPT 90837 and the allowed amount.
- Federal parity law requires comparable coverage for mental health when a plan covers it.
- Self-pay clients are entitled to a Good Faith Estimate, and HSA or FSA funds can often be used.
Tandem profiles show how each provider bills wherever they share it, whether in network, private pay, or with a superbill, so you can compare fit and cost among the verified mental health providers below.
References
- U.S. Department of Labor, Employee Benefits Security Administration. Mental Health and Substance Use Disorder Parity. https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-and-substance-use-disorder-parity
- U.S. Departments of Labor, Health and Human Services, and the Treasury. (2025, May 15). Statement regarding enforcement of the final rule on requirements related to the Mental Health Parity and Addiction Equity Act. https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-parity/statement-regarding-enforcement-of-the-final-rule-on-requirements-related-to-mhpaea
- Centers for Medicare & Medicaid Services. Understanding costs in advance (Good Faith Estimates). https://www.cms.gov/nosurprises/consumers/understanding-costs-in-advance
- HealthCare.gov. Mental health & substance abuse coverage (https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/); Health insurance plan & network types (https://www.healthcare.gov/choose-a-plan/plan-types/); Glossary: Out-of-pocket maximum/limit (https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/).
- Internal Revenue Service. Publication 502: Medical and Dental Expenses. https://www.irs.gov/publications/p502
- Internal Revenue Service. Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans. https://www.irs.gov/publications/p969