Understanding Out-of-Network Therapy

Out-of-Network 101: Using PPO Benefits for Therapy in NYC

Finding the right therapist in New York City can feel overwhelming—especially when insurance is involved. Many people assume they can only see therapists who are “in-network,” but if you have a PPO insurance plan, you may have more flexibility than you realize.

At Downtown Psychological Services, we regularly help clients understand and use their out-of-network benefits to make therapy more affordable. This guide breaks down the basics of using PPO benefits for therapy in NYC, so you can make informed decisions about your mental health care.

What Does “Out-of-Network” Mean?

When a therapist is out-of-network, it simply means they do not have a direct contract with your insurance company. This does not mean your insurance won’t help cover the cost.

If you have a PPO (Preferred Provider Organization) plan, your insurance typically allows you to:

See providers without referrals

Choose therapists outside your insurance network

Receive partial reimbursement for therapy sessions

This flexibility is especially important in NYC, where many highly specialized therapists choose to remain out-of-network.

Why Many NYC Therapists Are Out-of-Network

New York City has a large number of independent mental health practices. Many therapists opt out of insurance panels because:

Insurance reimbursement rates are often low

Panels limit session length or treatment options

Administrative requirements can reduce quality of care

By working out-of-network, therapists are often able to:

Offer longer or more consistent sessions

Specialize in areas like trauma, anxiety, relationships, or high-stress professions

Maintain greater clinical independence

For clients, this often means more choice and better therapeutic fit.

How PPO Out-of-Network Benefits Work

If you have a PPO plan, your insurance may reimburse a percentage of your therapy cost after you meet your deductible.

Here’s how it typically works:

You pay for the session upfront

You pay the therapist’s full fee at the time of service.

Billing support is provided

*You receive a detailed superbill that includes diagnosis codes, service codes, and provider information. *

For certain insurance carriers, Downtown Psychological Services submits claims on your behalf, reducing the administrative burden for clients.

Insurance processes the claim

When submitted—either by you or by our practice—insurance reviews the claim based on your out-of-network PPO benefits.

*You receive reimbursement * Depending on your plan, you may receive 50–80% of the “allowed amount” once your deductible is met.

Key Insurance Terms to Know

Understanding a few basic terms can make navigating PPO benefits much easier:

Deductible: The amount you must pay out of pocket before insurance starts reimbursing

Out-of-Network Coinsurance: The percentage insurance pays after the deductible (e.g., 70%)

Allowed Amount: The maximum amount insurance considers reasonable for a session

Out-of-Pocket Maximum: The most you’ll pay in a year before insurance covers 100%

Because NYC therapy rates can be higher than insurance allowed amounts, reimbursement may not equal the full session fee—but it can still significantly reduce costs.

Is Using Out-of-Network Benefits Worth It?

For many clients in NYC, the answer is yes.

Using PPO out-of-network benefits can:

*Expand your options for therapists * Allow you to work with specialists

Reduce long-term therapy costs

Eliminate the need for referrals or pre-authorizations

Many clients are surprised to learn that therapy becomes more affordable than expected once reimbursements begin.

How Downtown Psychological Services Helps

At Downtown Psychological Services, we aim to make therapy as accessible and transparent as possible. Our team:

Provides clear explanations of fees and billing

Has an accessible billing team available to answer all of your questions

Supplies detailed superbills for reimbursement

Submits insurance claims on your behalf for certain insurance carriers

Helps clients understand how to use their PPO benefits

Works with adults, couples, and professionals throughout NYC

Whether you’re new to therapy or switching providers, we’re happy to help you navigate the insurance process so you can focus on your mental health.

In-Network Insurance Options

While many clients choose to use out-of-network PPO benefits, Downtown Psychological Services is also in-network with:

Aetna

Wellfleet

Northwell Health

If you’re covered by one of these plans, you may be eligible for lower out-of-pocket costs.

Ready to Get Started?

Understanding your insurance shouldn’t be a barrier to getting support. If you’re considering therapy in NYC and want help figuring out your options—whether in-network or out-of-network—Downtown Psychological Services is here to guide you every step of the way. You can fill out this form to schedule a free 10-15 minute consultation with our intake team.