Before Your First Session: Everything You Need to Know About Using Insurance
Starting therapy is a meaningful step — and we want the practical side of it to feel as straightforward as possible. One of the most common questions we hear from new and prospective clients is: "How does insurance actually work here?" Insurance can feel like a maze of jargon, and the last thing we want is for confusion about coverage to get in the way of getting the support you deserve.
So let's walk through it together.
Are we in-network with your plan?
If your insurance card shows any of the following logos, you're likely in-network at our practice:
Aetna · Anthem · OPTUM · United Health Care · MetroPlus Health · Wellfleet
Being in-network means we bill your insurance company directly for your sessions — you don't have to submit claims yourself. We'll also work with your insurance ahead of your first appointment to get an estimate of what you'll owe, so you're not walking in blind. Whatever your share of the cost is, we'll collect that at the time of each session.
That said, every plan is a little different. Here are the key terms worth knowing so you can understand your specific benefits.
Key insurance terms, explained
Deductible
Many plans include an annual deductible — an amount you pay out-of-pocket across all your medical providers (doctors, hospitals, therapy, etc.) before your insurance starts covering costs. If you haven't met your deductible yet, you'll typically pay the full rate that your insurance company sets for your sessions.
The good news: we still submit claims to your insurer even when you're paying that full rate, so every payment counts toward your deductible. Once you've met it, your plan begins sharing the cost.
Deductibles reset every January 1.
Deductible waived for mental health
Here's something that surprises a lot of people: many plans today waive the deductible for mental health services entirely. That means you'd only pay a copay or coinsurance amount from your very first session — even if you haven't met your deductible for the year yet.
You can find out if this applies to you by reviewing your statement of benefits, or by calling the member services number on your insurance card and asking specifically about mental health visit costs.
Copay
A copay is a flat dollar amount your insurance plan sets for each visit. You pay that amount at the time of your session, and we bill your insurer for the rest. Simple and predictable.
Coinsurance
Rather than a flat fee, coinsurance is a percentage of the total billed amount that you're responsible for. Because it's percentage-based, it can shift slightly depending on the type of session — for example, a 60-minute session or group therapy may have a different cost than a standard 45-minute individual session.
Most of our clients are seen in 45-minute sessions, and we'll let you know your regular coinsurance amount upfront so there are no surprises.
Out-of-pocket maximum
If you have significant medical expenses in a given year, you may hit your plan's out-of-pocket maximum. Once you reach that threshold, your insurance covers 100% of the cost of your sessions for the rest of the policy year — you owe nothing more until the new year begins.
Not all plans include an out-of-pocket maximum, so it's worth checking yours.
A note on claim processing
All insurance plans come with an important disclaimer: benefits aren't fully confirmed until a claim is actually processed. We do our best to give you an accurate estimate of your costs before your session, but occasionally an insurance company will determine a different amount after the fact. If that happens, you'd be responsible for any additional balance owed — or if you were overcharged, we'll issue you a refund.
We know that kind of uncertainty isn't fun, which is why we work hard to get things right on the front end and communicate with you clearly throughout.
We're here to help you navigate this
Insurance is complicated — there's no way around that. But you don't have to figure it out alone. If you're unsure about your benefits, want help understanding what to ask your insurer, or just want to know what to expect before your first session, please reach out to us. We're happy to help you get clarity before you even walk through the door.
Your wellbeing is the priority. The paperwork is our problem to help solve.