A guide to understanding your insurance benefits
Common Insurance Terms—Explained Simply
Deductible
Your deductible is the amount you must pay out-of-pocket each year before insurance starts contributing.
Example:
If your deductible is $1,500, you pay the full session cost until you’ve paid $1,500 total that year.
Important mental health note:
Some plans waive deductibles for therapy
Others require you to meet the deductible first
In-network and out-of-network deductibles are often separate
Copay
A copay is a flat fee you pay per session once your benefits apply.
Examples:
$25 per therapy session
$40 per visit
Copays are most common with in-network providers.
Coinsurance
Coinsurance is a percentage you pay after meeting your deductible.
Example:
Insurance pays 70%
You pay 30%
If a session costs $150:
Insurance pays $105
You pay $45
Coinsurance is common for out-of-network mental health benefits.
Allowed Amount
The allowed amount is what your insurance decides a session is “worth”—not necessarily what the therapist charges.
Why this matters:
Insurance calculates reimbursement from this number
You may still owe the difference between the allowed amount and the therapist’s fee
Mental Health Parity: What You’re Entitled To
Under mental health parity laws, insurance companies must cover mental health care similarly to medical care.
This means:
Comparable copays and deductibles
No stricter limits for therapy than medical visits
Coverage for evidence-based treatments
That said, enforcement varies—and many plans still create barriers.
Questions to Ask Your Insurance Company (Script-Friendly)
When calling your insurance provider, ask:
Do I have out-of-network mental health benefits?
What is my in-network vs. out-of-network deductible?
What percentage do you reimburse for out-of-network therapy?
Is there a session limit per year?
Does trauma therapy or EMDR require prior authorization?
Pro tip: Write down the representative’s name and reference number.
In-Network vs. Out-of-Network: What’s the Difference?
In-Network Providers
An in-network therapist has a contract with your insurance company and agrees to their set rates.
What this usually means for you:
Lower out-of-pocket cost per session
Your insurance pays the therapist directly
You typically only pay a copay or coinsurance
Claims are handled automatically
Potential downsides:
Limited note-taking and diagnosis requirements
Fewer therapist options
Less flexibility in treatment length or type
Out-of-Network Providers
An out-of-network therapist does not have a contract with your insurance, but your plan may still offer partial reimbursement.
What this usually means for you:
You pay the therapist upfront
You submit claims (or use a reimbursement service)
Insurance reimburses you a portion of the fee
More flexibility and privacy in treatment
Why people choose out-of-network care:
Access to specialized trauma treatment (like EMDR)
Greater clinical autonomy
More privacy and less diagnosis-driven care
Choosing the Right Option for You
There is no “right” choice—only what works best for your needs, finances, and goals.
In-network may be best if you:
Want the lowest upfront cost
Prefer minimal paperwork
Are okay with limited provider choice
Out-of-network may be best if you:
Want specialized trauma care
Value privacy and flexibility
Are seeking deeper or longer-term treatment
Final Thoughts
Understanding insurance is hard—even for professionals. If you feel confused, it doesn’t mean you’re doing it wrong. It means the system is complex.
The most important thing to remember: you deserve access to quality mental health care, whether it’s in-network or out-of-network.
If you’d like help reviewing your benefits or understanding reimbursement options, many therapy practices are happy to walk you through it.
EMDR Therapy in Issaquah, WA | Serving Sammamish, Bellevue, North Bend & Snoqualmie
Virtual across Washington State.