Investing in Your Mental Health: A Guide to Payment Options for Therapy

Beginning therapy is a personal and meaningful decision, and understanding how to pay for care is an important part of the process. At Sustainable Wellness, we are committed to transparency and informed consent in all aspects of the therapy process—including finances. This guide is here to walk you through the different ways you can cover the cost of therapy, so you can make informed decisions that work for your needs and your budget.

Payment options for therapy

When it comes to paying for therapy, you have a few options—most which fall under these three categories:

1. In-Network Insurance

2. Out-Of-Network Insurance

3. Self (Private) Pay

   
   

Let's break this down:

In-Network Insurance

When you think of finding a therapist who "takes your insurance," you're thinking of in-network therapists. This means a therapist (or practice) has contracts in place with a particular insurance company to offer therapy services at an agreed-upon rate that is a lower out-of-pocket cost to you.

Once you confirm that a therapist is in-network with your insurance,  we always recommend contacting your insurance company directly to see what your specific plan covers. Most health insurance plans include some level of coverage. However, the specific amount covered can vary depending on your specific plan and type of therapy you're looking for. Helpful questions to ask your insurance provider include:

• Do I have outpatient mental health or behavioral health benefits?

• Do I have a deductible (and, if so, how much is it and how much has been met)?

• What is my copay or coinsurance for mental health visits?

• Are Telehealth services covered under my plan?

Our practice is In Network with several insurance providers

Our practice is in-network with several insurance companies. If you have an insurance plan that we accept, we will verify your benefits prior to starting therapy services and bill your insurance directly after each of your visits. Check out our Rates & Insurance page, or contact us directly for the most up-to-date information. We’re happy to answer any questions!

Out-of-Network (OON) Insurance

"Out of Network" means your therapist (or practice) does not have a contract with your insurance company. In many cases, you can still use your insurance to get partial reimbursement for therapy, but it may be a higher out-of-pocket expense compared to seeing an in-network therapist.

Coverage varies widely by insurance plans—some offer great out-of-network benefits, while others don't offer OON benefits at all. Understanding your plan’s OON benefits can help you make informed decisions about your care and costs.

There are several ways to use OON insurance for therapy, although the available methods depend on your insurance plan and what your therapist offers:

Out-of-Network Billing

Out-of-Network billing means your therapist bills your insurance company on your behalf, just like for in-network plans. This helps reduce the need for clients to submit paperwork themselves—a reality that often exists when using OON benefits due to there being no contracts between therapists and insurance providers.

 Sustainable Wellness offers this for several insurance providers. For this process, our team:

• Collects your insurance information during intake

• Verifies your out-of-network mental health benefits

• Submits claims electronically after each session

• Monitors claim status and notify you if any issues arise

Please note that not all insurance plans allow third-party submission of OON claims, so we are only able to do this with some providers. Our Rates & Insurance page has the most up-to-date information about our OON billing options, or you can always contact us directly for more information.

Submit OON claims yourself (Superbills)

If your insurance provider requires that you submit your own claims, or OON billing is not an option for other reasons, your therapist may be able to provide you with a superbill to send your insurance company for reimbursement of services. Superbills are essentially detailed receipts tailored specifically to include everything insurance would need to determine eligibility for reimbursement.

When using superbills, clients are required to pay up front for the cost of therapy. Sustainable Wellness provides superbills to the client (usually on a monthly basis), and the client submits the superbill directly to their insurance company. The insurance company then processes the claim and, if eligible, the client will receive (partial) reimbursement for the session. The reimbursement money is paid directly to the clients—not to the therapist or practice.

Courtesy Billing

Courtesy billing means your therapy provider submits OON claims to insurance on your behalf as a "courtesy." In these cases, you would pay the full fee up front (just like with a Superbill), but the therapist submits the claim to insurance for you, so you don't have to track the claim yourself. In these cases, the insurance company reimburses you, the client, directly, since you already paid the practice.

Unlike with superbills, which are submitted by the client, courtesy billing is always completed by the therapist or practice. It's important to note that insurance companies may only reimburse the amount that is contractually obligated by the client's insurance plan, so full reimbursement is not guaranteed.

As of the time this post was written, Sustainable Wellness does not offer Courtesy Billing, however the practice does offer Superbills and OON billing for eligible insurance companies. Given our resources as a small group practice paired with our efforts to make insurance billing as simple as possible for clients, we believe our resources are best suited for these two focus areas.

Self Pay

Self-pay (also called private pay) means clients pay for therapy sessions out of pocket, without involving an insurance company. While it can be more expensive, there are reasons why clients may choose to keep insurance out of the therapy space:

• More privacy: With self pay, your therapy records are never shared with your insurance company.

• Greater flexibility: You and your therapist decide what’s best for your care, not your insurance.

• Shorter wait times: You may be able to start therapy more quickly with therapists who don't take insurance given the high demand of those wanting to use in-network benefits.

• No required diagnosis: Insurance requires a mental health diagnosis for reimbursement, while self-pay does not.

• Access to non-billable sessions: Self pay often allows access to certain types of therapy that insurance does not cover, including couples therapy, psychedelic-assisted therapy (KAP, MDMA, etc.), "intensive" sessions that last longer than 53 minutes, and integrated services like reiki, yoga, and energy healing. *Note that, while Sustainable Wellness offers many of these types of services, not all therapists do.

Overall, self pay gives clients full control over their therapy, including the choice of therapist, the length and frequency of sessions, and the type of treatment you receive—without needing a diagnosis or insurance approval.

Other key terms when using insurance

Understanding a few insurance basics can go a long way. Here is a list of key terms to know when using insurance for therapy:

• Premium - The amount you pay each month to have health insurance—even if you don’t use it.

• Copay (or Copayment) - A fixed amount you pay for each therapy session (i.e. $20 per visit), usually due at the time of service.

• Deductible - The amount you must pay out-of-pocket each year before your insurance starts covering services. For example, if your deductible is $1,500, you’d pay the full session rate until you’ve reached your deductible amount. If using in-network benefits, this would be the session rate contracted between your therapist and insurance plan. If OON, this would be the therapist's self-pay rate.

• Coinsurance - This is similar to a copay, but typically more specific to deductible plans. After you meet your deductible, your insurance plan will start covering a percentage of the total fee per session. Coinsurance is the percentage you still owe. For example, if you have a 20% coinsurance amount, insurance will cover 80% of the session rate and you'd pay the remaining 20% each session.

• Explanation of Benefits (EOB) - A statement from your insurance company showing how a claim was processed, including how much insurance paid and didn't pay, and what you still owe.

• Prior Authorization - This is a requirement from your insurance plan asking for you to get approval for a service in order to cover therapy. Not all therapists or services require this, but it's important to check in advance.

• Medical Necessity - Insurance only pays for services they define as medically necessary, meaning there must be a formal diagnosis and a treatment plan aimed at improving symptoms.

• Out-of-Pocket Maximum - This is the most you’d have to pay out of pocket in a year when using insurance. Once you reach this amount, your plan should cover 100% of eligible costs for all of your healthcare services.

We’re here to help!

Our team is committed to helping you understand your payment options for therapy and access the support you need. If you’re unsure about your benefits or how to get started, contact us—we’re happy to help you navigate next steps.