Why Therapy Can Still Be Expensive With Insurance (and How to Check Your Benefits)
If you have ever tried to use insurance for therapy and felt confused or stressed, you are not alone. I remember when I thought I finally had “good” insurance so I could begin my own therapy. However, I ended up with a surprise bill and did not receive much explanation at the time. Because of that, I stopped therapy immediately. Have you experienced that as well?”
Many people expect therapy to be “covered” by their insurance plan, but then feel surprised or shocked when they see a deductible, coinsurance, or a higher-than-expected out-of-pocket cost—especially at the beginning of the year, when most insurance plans reset deductibles at the start of the calendar year (January 1), even if the plan renews or changes at another time during the year (such as July 1).
In this post, I’ll explain (in plain English) why therapy can still feel expensive with insurance, and how to check your benefits so you can avoid surprises.
“Covered” does not always mean “low cost”
Even when therapy is covered by insurance, your cost depends on the details of your plan, including:
deductible
copay or coinsurance
whether your therapist is in-network
whether your plan is an HMO/EPO-style plan (in-network only)
What is a deductible?
A deductible is the amount you may need to pay out-of-pocket before your insurance begins paying more toward covered services.
Important note: Some plans apply the deductible to therapy, and others do not. That’s one reason costs can vary so much from plan to plan.
Copay vs coinsurance (this matters a lot)
Your plan may list your therapy cost as either a copay or coinsurance.
Copay (example: $25 per session or per visit)
A copay is a fixed amount you pay for each session (once coverage applies).
Coinsurance (example: 20% or 30%)
Coinsurance means you pay a percentage of the allowed amount (the rate your insurance sets), and insurance pays the remaining percentage.
In-network vs out-of-network
In-network:
Insurance companies usually have networks of “in-network” providers. In-network providers typically offer the most insurance coverage and the lowest out-of-pocket cost, compared to out-of-network care. Terefore, if your therapist is in-network, you typically pay less (depending on your deductible and benefits).
Out-of-network:
Some plans still offer out-of-network benefits (you may be able to submit a superbill for reimbursement)
Other plans do not cover out-of-network therapy at all
Why your cost may be higher at the beginning of the year
Many insurance plans reset on January 1st. That means:
deductibles restart
out-of-pocket maximums restart
clients often notice higher costs in January–March until more of their yearly expenses are applied
To avoid disappointment and protect yourself from receiving a surprise bill, here’s how to check your therapy benefits: (quick checklist)
One of the best ways to avoid surprise bills is to check your member portal (or call the number on the back of your insurance card) before you reach out to a therapist and ask:
Is outpatient mental health covered?
Does my deductible apply to therapy sessions (60 minutes psychotherapy)?
Do I have a copay or coinsurance for therapy?
Is my therapist in-network for my specific plan?
Do I have out-of-network benefits for mental health?
Do I need prior authorization for outpatient therapy?
A gentle note about estimates
I’m always happy to help clients understand general insurance information and verify benefits when possible. However, I am not an insurance specialist, and the most accurate information comes directly from your insurance plan. Your final responsibility is determined when your claim is processed.
If cost is a concern, you are not alone. We can talk about options such as meeting bi-weekly, adjusting session frequency, or creating a plan that feels both emotionally supportive and financially sustainable.
Final thoughts
Insurance can be stressful—especially when you’re already feeling anxious, depressed, overwhelmed, or trying to get help quickly.
You deserve care that feels clear, supportive, and safe. If you have questions about using insurance for therapy, you’re welcome to reach out.
Trauma Therapy Chicago LLC is in-network with BCBSIL PPO plans, Optum/UnitedHealthcare PPO plans, and Aetna PPO plans. Please note that we are not in-network with HMO plans, and POS/EPO plans may not cover out-of-network services. Please confirm your specific plan benefits directly with your insurance.
