Out-of-Network Cost Calculator

What does out-of-network mean?

An out-of-network (OON) provider doesn't have a contract with your insurance company. You pay the provider directly, then your plan may reimburse part of what you paid, as long as your plan includes out-of-network benefits. Many PPO and POS plans do; most HMO and EPO plans do not.

Being out-of-network is common for psychologists and doesn't mean your care isn't covered. It changes how the money moves: instead of a copay at the visit, you pay the fee and your plan pays you back later through a superbill.

What is a superbill and how do I use it?

A superbill is an itemized receipt with the diagnostic and billing (CPT) codes your insurer needs to process a claim. After your sessions, I provide one on request. You submit it to your insurance company, by their portal, app, or mail, and they apply it to your out-of-network benefits.

Reimbursement goes to you, not to me, since you've already paid for the sessions. Turnaround varies by plan, from a couple of weeks to a couple of months.

How do I find my deductible, coinsurance, and allowed amount?

Call the member services number on the back of your insurance card and ask four things: Do I have out-of-network outpatient mental health benefits? What is my out-of-network deductible, and how much have I met this year? Once it's met, what percent do you reimburse? And what is the allowed amount for CPT codes 90834 and 90837 for an out-of-network psychologist?

The allowed amount is the number people most often miss, and it's the one that most changes your estimate. Insurers reimburse a percentage of their allowed amount, not of the full fee, so knowing it turns a rough guess into a realistic plan.

Why might my real reimbursement differ from this estimate?

This calculator models the common case: a deductible, a coinsurance percentage, and an allowed amount. Real plans add wrinkles, such as separate out-of-network out-of-pocket maximums, visit limits, medical-necessity review, or a different allowed amount than you were quoted. Claims can also be processed differently than expected.

Treat the result as a planning range, not a promise. The most reliable numbers always come from your own insurer in writing.

Is the calculator private?

Yes. Everything runs in your browser. Nothing you type is sent anywhere, saved, or seen by me or anyone else. Refreshing the page clears it.