Let’s say the therapist charges $150/session. This is the amount you pay at the end of each of your sessions. The therapist will give you a receipt that you send back to your insurance company for reimbursement.
Let’s say your out-of-network annual deductible is $1500. Using the rate of $150 a session as an example, you would need to pay for the first 10 sessions before the reimbursement benefit starts.
Let’s say after the first 10 sessions, counseling is going well; you are making progress and there is a need to continue. Starting on the 11th session, you are eligible to receive a percentage of the next payments to your therapist back to you from your insurance company. The percentage rate varies and depends on what your employer has negotiated with the insurance company for your specific policy/pool of employees. As a simple example, let’s say the percentage rate is 60% based on the insurance company’s base rate of $100.
What this means is that starting on the 11th session, the insurance company should be reimbursing you for 60% of their internal rate of $100 or $60. It is important to note that it is NOT 60% of the therapist’s rate of $150. So in our example you would be paying the therapist $150 for the session and your insurance company would pay you back $60, so in effect you are paying $90 out of pocket.
Usually the annual deductible is calculated based on the calendar year so starting in January each year, the annual deductible resets and you would need to pay the first $1500 yourself again. So if you have longer term, more serious symptoms, it is to your benefit to start therapy earlier in the calendar year so that you pay for the annual deductible and can get the benefit of the ensuing reduced cost of sessions if you need longer term therapy.