Most people in New York City who have a PPO insurance plan, through an employer or purchased independently, have out-of-network mental health benefits they’ve never used. These benefits exist specifically to reimburse a portion of therapy costs when you see a therapist who doesn’t accept your insurance directly. The reimbursement rate on most PPO plans runs 50–80% of the session cost after your deductible, which changes the math on out-of-network therapy significantly.
NYC Psychotherapy Cooperative at 113 University Place is an out-of-network practice. This guide explains exactly how out-of-network therapy and superbill reimbursement work, what to ask your insurance company before your first session, and why many New Yorkers actively seek out-of-network therapists rather than settling for whoever is in their plan’s network.
What “Out-of-Network” Means for Therapy in NYC
An in-network therapist has a contract with your insurance company that sets a negotiated rate. You pay a copay; the insurance company pays the rest directly to the therapist. The tradeoff: the pool of in-network therapists is finite, waitlists for in-network providers in NYC are often months long, and the therapists available in-network may not specialize in what you need.
An out-of-network therapist doesn’t have a direct contract with your insurance company. You pay the full session fee upfront, then submit a document called a superbill to your insurance company for reimbursement. Depending on your plan and deductible status, you receive a check back covering 50–80% of the session cost.
The practical effect: with active PPO out-of-network benefits, a $250 session at NYC Psychotherapy Cooperative might ultimately cost you $50–$125 after reimbursement, close to or comparable to what many in-network copays effectively cost for premium plans.
What a Superbill Is and How It Works
A superbill is an itemized receipt of your therapy sessions containing all the information your insurance company needs to process a claim. NYC Psychotherapy Cooperative provides superbills that include:
- The practice’s NPI (National Provider Identifier) number
- The therapist’s license information and credentials
- Diagnosis code (ICD-10), the clinical code identifying why you’re receiving treatment
- Procedure code (CPT code), the billing code identifying the type of session (typically 90837 for 60-minute individual therapy)
- Date of service
- Amount paid
You receive a superbill monthly (or after each session, depending on your preference), submit it to your insurance company with a claim form, and receive reimbursement by check or direct deposit. Most insurance companies process claims within 2–4 weeks.
Before Your First Session: What to Ask Your Insurance Company
Call the member services number on the back of your insurance card and ask these questions before starting out-of-network therapy:
“Do I have out-of-network mental health benefits?” If your plan is an HMO, the answer is likely no. If it’s a PPO or EPO with out-of-network benefits, the answer is likely yes.
“What is my out-of-network deductible for mental health, and have I met it?” Your out-of-network deductible is the amount you pay entirely out-of-pocket before reimbursement begins. If your deductible is $1,000 and you’ve already paid $600 toward it this year, you’ll reach reimbursement faster than if you’re starting from zero.
“What percentage does my plan reimburse for out-of-network mental health services after the deductible?” The typical answer for PPO plans in NYC is 50–80% of the plan’s “allowable amount,” which may be different from what your therapist actually charges. Ask what the allowable amount is for CPT code 90837 (standard 60-minute therapy session) to get a realistic estimate.
“How do I submit claims for out-of-network services?” Most insurers have an online portal for claim submission. Some still require mailing paper claim forms. Get the specific process before starting, so there are no delays in reimbursement.
Why Many New Yorkers Choose Out-of-Network Therapists
- Access to specialists. In-network therapy in NYC is constrained by who has contracts with your specific insurer. The therapists at NYC Psychotherapy Cooperative, licensed clinical social workers and a PhD psychologist with training in EMDR, somatic therapy, and interpersonal approaches, represent a level of specialization that isn’t always available within narrow insurance networks. You can learn more about our team on the psychotherapy team page.
- No authorization requirements. In-network therapy often requires pre-authorization from your insurance company before treatment begins, annual session limits, and ongoing documentation of “medical necessity” that can interfere with the therapeutic relationship. Out-of-network therapy involves none of these administrative constraints.
- Actual availability. In-network therapist waitlists in NYC can run 2–6 months. NYC Psychotherapy Cooperative has current availability for new clients.
- Continuity of care. When therapists leave insurance networks, which happens regularly due to administrative burden and low reimbursement rates, in-network clients lose their provider. Out-of-network relationships aren’t subject to this disruption.
- Privacy. Out-of-network therapy involves less documentation submitted to insurance companies, an important consideration for professionals in careers where mental health records could be sensitive.
About NYC Psychotherapy Cooperative
NYC Psychotherapy Cooperative is a Union Square therapy practice with three licensed therapists: Rita Gazarik (LCSW), Brannan Piper (LCSW), and Mary Hayley (PhD). The practice specializes in anxiety, depression, PTSD, trauma, couples therapy, and family counseling using evidence-based modalities including EMDR, IPT, somatic therapy, and mindfulness approaches.
Sessions are $200–$275. The practice is out-of-network with all insurance plans and provides superbills for reimbursement. A limited sliding scale is available in select circumstances.
Location: 113 University Place, 10th Floor, New York, NY 10003, directly accessible from Union Square (4/5/6/L/N/Q/R/W trains). Hours: Monday–Saturday, 9 am–7 pm.
Frequently Asked Questions
What is an out-of-network therapist in NYC?
An out-of-network therapist doesn’t have a direct contract with your insurance company. You pay the full session fee upfront, then submit a superbill, an itemized receipt, to your insurer for reimbursement. Most PPO plans reimburse 50–80% of the session cost after your deductible. NYC Psychotherapy Cooperative at 113 University Place is an out-of-network practice that provides superbills for all sessions.
How much does out-of-network therapy cost after reimbursement in NYC?
The net cost depends on your plan’s reimbursement rate and whether your deductible is met. With a 70% PPO reimbursement rate on a $250 session, your effective out-of-pocket cost is $75 per session after reimbursement. Calculate your estimate by asking your insurer about the reimbursement percentage for CPT code 90837 and your current out-of-network deductible status.
What does a superbill include?
A superbill includes the therapist’s NPI number and credentials, your diagnosis code (ICD-10), the procedure code for the type of session (CPT 90837 for 60-minute therapy), the date of service, and the amount paid. NYC Psychotherapy Cooperative provides superbills that contain all the required information for insurance claim submission.
How do I submit a superbill to my insurance company?
Most insurance companies accept superbill claims through their online member portal or by mail with a claim form. Log into your insurance company’s member portal and look for “Submit a Claim” or “Out-of-Network Claims.” Attach your superbill and complete the claim form. Processing typically takes 2–4 weeks. Call member services if your claim is not processed within 30 days.
Do HMO plans cover out-of-network therapy?
Generally no. HMO plans require you to use in-network providers and typically don’t reimburse out-of-network services except in emergencies. PPO and some EPO plans typically include out-of-network mental health benefits. Check your insurance card for your plan type and call member services to confirm your specific benefits before starting therapy.
Why would I choose an out-of-network therapist over an in-network one?
Access to specialists, shorter waitlists, no insurance authorization or session limits, and continuity of care. In New York City, in-network therapist waitlists often run 2–6 months. Out-of-network practices like NYC Psychotherapy Cooperative have current availability and aren’t constrained by insurance documentation requirements that can affect the therapy relationship. You can explore our full range of services or contact us to check availability.
Rita Gazarik, LCSW, is a psychotherapist with more than 30 years of experience helping couples, families, and individuals strengthen relationships and navigate life’s transitions. Known for her compassionate and collaborative approach, Rita helps clients improve communication, rebuild intimacy, and work through conflict with greater understanding. She also leads workshops for newly married couples and second marriages. Rita is the director of Family Life Associates in NYC and co-founder of Ready Set Relationship.