Out-of-Network Benefits & Insurance
Resilience Restored Psychotherapy (RRP) is an out-of-network mental health practice. This means we do not participate directly with insurance panels. Instead, we provide documentation that you may submit to your insurance company for possible reimbursement.
Did you know that you may still be eligible for insurance benefits anyway? The majority of people in the NY Metro area are. Many people assume out-of-network therapy means no insurance coverage at all, but that is often not the case. Many clients receive partial reimbursement, depending on their individual plan.
In the NJ and NY region, many PPO and POS plans include out-of-network mental health benefits, though coverage levels vary. This can meaningfully help you pay for high quality, expert mental health care.
Key Differences Between In-Network and Out-of-Network Therapy
Aspect of Care | Out-of-Network Therapist | In-Network Therapist |
Focus of the Session | ✅ Sessions tend to be more individualized, with therapists able to devote their full attention to each client. | ⛔ Larger caseloads can mean less time per client and more standardized care. |
Pace of Treatment | ✅ Therapy can move at the pace that best serves the client’s needs and goals. | ⛔ Insurance policies often influence session frequency or length of treatment. |
Financial Structure | ⛔ Clients typically pay the session fee upfront but may receive partial reimbursement from their insurance plan depending on out-of-network benefits. | ✅ Usually involves a fixed copay or coinsurance determined by the insurance company. |
Scheduling Availability | ✅ Appointments are often available sooner and scheduling tends to be more flexible. | ⛔ Demand for in-network providers may lead to longer waitlists. |
Professional Development | ✅ Many out-of-network clinicians invest heavily in specialized training and advanced clinical education. | ⛔ Insurance reimbursement pressures can limit time and resources for additional training. |
What Does Out-of-Network Mean for You?
Choosing an out-of-network therapist often allows for:
- Greater privacy and confidentiality
- More individualized, depth-oriented care
- Greater flexibility in treatment length and frequency
- Access to highly specialized clinicians
While there is typically an upfront out-of-pocket cost, many clients find the flexibility and personalization well worth the investment in their care.
Potential Insurance Reimbursement
Most PPO and POS plans include out-of-network benefits. If your plan includes these benefits, you may be reimbursed for a portion of our fees.
Reimbursement depends on:
- Your out-of-network deductible
- Your coinsurance percentage
- Your plan’s allowed amount
Our Values
Compassion
Warmth
Trust
Expertise
Safety
Kindness
Simple Reimbursement Example
Here is a sample scenario to help you estimate possible reimbursement:
- Session fee: $200
- Your plan reimburses: 60% after deductible
- Insurance allowed amount: $200
Insurance pays: 60% of $200 = $120
Your estimated cost per session: $80
Every plan is different, but this example illustrates how out-of-network benefits can significantly reduce your out-of-pocket cost and make high quality, expert mental health care affordable for you.
How RRP Supports You
We aim to make the reimbursement process as straightforward as possible.
We provide:
- Monthly superbills with required billing codes
- Clear documentation for submission
- Guidance on how to check your benefits
Please note: We do not communicate directly with insurance companies and cannot guarantee reimbursement.
Questions to Ask Your Insurance Company
When you call your insurance provider, you may wish to ask:
- Do I have out-of-network mental health benefits?
- What is my out-of-network deductible?
- What percentage do you reimburse for outpatient psychotherapy?
- What is the allowed amount for CPT codes 90791, 90834, and 90837?
- Is telehealth covered for out-of-network providers?
- Is pre-authorization required?
Why Many Clients Choose Out-of-Network Care
Insurance-based therapy can be helpful for many people. However, some clients choose out-of-network care because it often allows for:
- A stronger focus on clinical needs rather than insurance limitations
- More flexibility in session frequency and duration
- Greater privacy in some cases
- Access to specialized therapeutic approaches
- A deepening of previous therapeutic work
At RRP, our goal is to provide thoughtful, individualized care tailored to your unique needs and goals.
Frequently Asked Questions
We want to make high quality, expert mental health care affordable for you.
1.Do most clients receive reimbursement?
Estimates suggest that 55-70% of people in the NYC metro area have OON mental health coverage and receive reimbursement. Many are unaware that they have this benefit.
2. How long does reimbursement take?
Most insurance companies process claims within 2–6 weeks after submission, though timing varies.
3. Do you submit claims for me?
No. We provide superbills that you submit directly to your insurance company.
4. Can you estimate my reimbursement?
We can help you understand the process and what questions to ask your insurer, but only your insurance company can quote exact reimbursement.
5. What if I have a high deductible?
Many clients use HSA or FSA funds to pay for therapy until their deductible is met.
Our Specialties
Clients often seek us out for depth-oriented and trauma-informed therapy, as well as therapy for children and teens. Learn more about:
- Teen Therapy → https://www.resiliencerestored.com/teen-therapy
- Child & Play Therapy → https://www.resiliencerestored.com/child-play-therapy
- Trauma & PTSD Therapy → https://www.resiliencerestored.com/trauma-ptsd
- Anxiety & Stress Therapy → https://www.resiliencerestored.com/anxiety-stress
- Depth-Oriented Therapy → https://www.resiliencerestored.com/depth-oriented-therapy
- AEDP (Accelerated Experiential Dynamic Psychotherapy) → https://www.resiliencerestored.com/aedp-therapy-montclair/
- DBT & Emotion Dysregulation → https://www.resiliencerestored.com/emotion-dysregulation-and-dbt-in-montclair-nj-and-nyc/
- LGBTQ+ Affirmative Care → https://www.resiliencerestored.com/lgbtq-affirmative-therapy/
- Culturally-Informed Therapy → https://www.resiliencerestored.com/culturally-informed-therapy/
Fees
Our fee range varies by clinician and service. Specific fees are discussed during the consultation process.
Payment is due at the time of service.
Ready to Get Started?
If you have questions about fees or insurance reimbursement, we are happy to help you think through your options.
Resilience Restored Psychotherapy
Montclair, NJ
www.resiliencerestored.com
(201)-292-0581 | info@resiliencerestored.com