Out-of-network means that a healthcare provider does not have a contract with your health insurance plan provider. Most PPO and POS plans reimburse around 50-80% for out-of-network providers. Most HMO and EPO plans will not cover care from out-of-network providers at all, except sometimes in cases of an emergency.

For example, New Brunswick Therapy is not contracted with UnitedHealthcare or Cigna. We are also not contracted with Medicare or Medicaid, even if they are provided by BCBS or Aetna. That means we are an out-of-network provider for these insurance provider plans.

Out-of-network reimbursement means that you would be responsible for paying the full fee for services up front and your health insurer reimburses you a percentage of the total cost.

An out-of-network deductible is the amount of money you are responsible for paying before you are eligible for reimbursement from your insurance.

Example: You have an out-of-network deductible of $1,000 and your insurance company pays for 80% of services after you have met that amount. That means you would have to pay $1,000 out-of-pocket, after which you will have “met your deductible,” then 20% of all sessions thereafter. In this scenario, if you have spent $1,500 on therapy services, you would have paid $1,100 out-of-pocket, and the remaining $400 would be reimbursed to you in the form of a check that is mailed to you from your insurance company after you submit your claim.

Deductibles reset every calendar year, and any health expenses you pay out-of-pocket contributes to meeting it.

Coinsurance is the percentage of the service fee that you are responsible for paying.

Example: At New Brunswick Therapy, we charge a service fee of $175 for a therapy session. If your out-of-network insurance policy only covers $160 of $175 for a therapy session and your coinsurance is 30%, that means you would be responsible for paying $63 per therapy session (i.e., $160 x 30% + $15). Just remember that this comes in the form of a reimbursement, so you’ll need to pay the full amount of $175 up front, then your insurance will send you a check for $112 for therapy. You will likely receive the check by mail after the session, once you have met the deductible and submitted a claim.

Some insurance companies determine an “allowed amount,” which limits the session fee they will cover. If your insurance has determined $100 is their “allowed amount” per session, at a 30% coinsurance rate, your insurance company will still only reimburse you up to $70, no matter what our therapists’ session fees are. In other words, if your insurance has an allowed amount of $100 but your therapist’s session fees are $175 per therapy session, you won’t get reimbursed more; you’ll still be reimbursed $70, and you will be responsible for $105.

Your out-of-network benefits are usually listed in the Summary of Benefits information on your insurance company’s website or by calling the Member Services number on the back of your health insurance card.

You are encouraged to contact your insurance company and ask them:

1. Is out-of-network reimbursement included in my plan?

2. Can I see an out-of-network provider for outpatient mental health?

3. What percentage of the fee will you cover for a 60-minute outpatient individual psychotherapy session? How much will I be reimbursed?

Your insurance company may request the following information about New Brunswick Therapy:

Practice Name: New Brunswick Therapy LLC

CPT Codes:
Intake online: 90791-95
Intake in-person: 90791
Individual therapy online: 90837-95
Individual therapy in-person: 90837

NPI Type 1: 126-508-0345

NPI Type 2: 140-759-2496

Mental health provider, outpatient

Place of service: Telehealth or Office

Doctoral-level provider (clinical psychologist)

4. What is my out-of-network deductible? How much of my out-of-network deductible has been met this year?

5. What, if any, are the limitations on number of sessions and/or dollar amount per calendar year?

6. Do I need a referral from an in-network provider to see someone out-of-network?

7. How do I submit claim forms for out-of-network reimbursement?

8. How long will it take for me to receive out-of-network reimbursement?

The answers to these questions will explain what your out-of-pocket expenses will be.

After you confirm your out-of-network benefits with your insurance provider, you would then pay New Brunswick Therapy LLC directly for services by card, and then you submit a detailed receipt that we provide you (referred to as a superbill) to your insurance. From there, your insurance should mail you back a check for a percentage of what you paid us.

Most PPO plans reimburse around 50-80% for out-of-network providers.

Example: Our billable out-of-pocket rate is $175 for therapy and some clients have 70% reimbursement after they have met their out-of-network deductible (if they have one). If your benefits are similar, you would hopefully only be paying around $52.50 per therapy session when the out-of-network reimbursement is accounted for. In principle, it is pretty simple, but it can be cumbersome to do depending on your insurance provider.

For your convenience, we generate superbills for you on the first weekend of the month for all sessions that occurred during the month prior. We will upload your superbill to your TherapyPortal™ client portal, where you can download the document. From there, you may be able to upload the superbill to your insurance’s online portal (or whichever method they want you to submit claim forms) and then your insurance company would send you a check. 

New Brunswick Therapy will also send you a "Good Faith Estimate" of expected charges, which explains how much your medical care will cost. Learn more about Good Faith Estimate by going to www.newbrunswicktherapy.com/goodfaith