Insurance and Out-of-Network Coverage

I would be considered an out-of-network provider. In this case, there are many insurance companies that reimburse for psychotherapy services. The following carriers typically reimburse between 40-70% of the fee, if you have out-of-network behavioral health benefits. Keep in mind that most plans require you to pay a deductible first and to contribute a co-payment.

For out-of-network coverage, clients are expected to pay for sessions each month and submit their own claims for reimbursement.

Out of network plans include but are not limited to:

  • Aetna/Aetna Student Health
  • United Healthcare
  • CHP/ Consolidated Health Plans
  • Oxford
  • Empire Blue Cross/Blue Shield
  • Amerihealth

The mental health practitioner license I operate under in New York is titled “LCAT” and stands for Licensed Creative Arts Therapist. It is always good to call your plan in advance to learn what benefits are available to you.

Questions to ask your insurance provider

  1. Does my plan have out-of-network benefits?
  2. Do I have a deductible? If yes, how much is it? Have I met any portion of my deductible with other medical expenses this year?
  3. Is there a limit on the number of “outpatient” mental health or psychotherapy sessions I am entitled to per year?
  4. Does my plan require pre-authorization or a referral from an MD or Primary Care Physician?
  5. What amount of the psychotherapy (CPT 90837) fee will be reimbursed?
  6. Is my coverage different for biological vs. non-biological conditions?
  7. Do you require an LCSW-R, PhD, or MD level practice license?