The decision to go out-of-network was not easy. But if you have ever tried to access mental health care through insurance, you already know the system was not exactly built with you in mind. After years of navigating panels, prior authorizations, clawbacks, underpayment, no payment, and the hidden yet very real ways managed care shapes clinical decisions, we chose to step fully outside that structure. Out-of-network therapy can still be accessible, and we continue to strive to remain accessible to those who need services.

What Insurance-Based Therapy Actually Costs You and Your Provider

Here is the truth that nobody puts in the fine print. When a therapist bills your insurance, your most personal struggles become a billable diagnosis attached to your name, potentially forever. Insurance companies dictate how often you come in and decide what counts as “medically necessary.” They also reserve the right to audit your records. Your clinician isn’t fully in the driver’s seat. Your insurer is.

Also, when your therapist decides to panel with your insurance company, they agree to a contracted rate. Many times, this contracted rate is way below their usual fee, and the insurance company does not provide rate increases to keep pace with inflation.

For example, Cheerful Heart had been paneled with Aetna, United, Cigna, and several other plans for almost eight years. The only panel that gave an increase yearly was Cigna, and Cigna was giving $1 a year for the most-billed code I use for services, which is a 53-minute-or-longer psychotherapy session. UnitedHealthcare and Aetna refused to give me increases for the entire eight years I had a contract with them.

Like many other practices, Cheerful Heart signed up with venture-capital-backed companies, themselves funded by major insurance companies, to get what they called “enhanced rates.” But ultimately, these companies exist to lock therapists out of the market and devalue our work, turning therapy into a gig-economy job. These companies also do not offer increases. They start you at a higher rate, which appeals to many therapists who need to pay their bills while remaining accessible by taking insurance. Recently, they have started cutting services and imposing rules that save the insurance companies money at the providers’ expense.

 

How does going out-of-network help?

By leaving insurance panels, your therapy stays between you and your therapist, so we can focus more on your care. Your therapist also no longer has to work an unmanageable number of hours across several different companies just to serve you and make ends meet. This means more effective work and more personal attention for you.

One honest caveat about superbills. If you have out-of-network benefits and decide to submit a superbill to your insurance for partial reimbursement, the picture changes slightly. To process that claim, your insurer will require a diagnosis because that is what they reimburse. Depending on your plan, you may also run into some of the same constraints that come with in-network care, such as medical-necessity reviews or limits on how many sessions they will count. This part is genuinely unpredictable and depends entirely on your specific policy, so it is worth calling your insurer to ask what your out-of-network mental health benefits actually look like before you rely on them. Everything above holds fully when you pay privately and skip reimbursement. The moment you bring your insurer in, even out-of-network, some of their rules come back into play.

 

What We Built Instead: The Community Care Agreement

Because accessibility still matters deeply to us, Cheerful Heart operates on a Community Care Agreement rooted in anti-racist, anti-oppressive values. This is not a standard sliding scale. It is a tiered, equity-based pricing structure that takes into account the real economic disparities that disproportionately affect BIPOC communities and people with chronic illness.

If you have financial privilege, paying the full rate directly subsidizes access for clients who do not. If you are navigating financial hardship, we do not penalize you for it or make you feel like a charity case. We simply meet you where you are, because that is what community care actually means.

This model grows from the belief that healing is a communal act. When we resource each other, we all benefit and can make out-of-network therapy more accessible.

 

A Few Practical Notes

While Cheerful Heart does not bill insurance directly, you may still be eligible for reimbursement through your out-of-network benefits. Many PPO plans cover a meaningful portion of telehealth therapy costs, and I am happy to provide a superbill. A superbill is an itemized receipt you can submit to your insurer. It is worth a quick call to your member services line to ask what your plan covers as well, since most out-of-network plans start with a deductible and then your insurance pays a coinsurance amount (usually ranging from 40% to 80%).

We also accept FSA and HSA cards, making it possible to use pre-tax dollars toward your care.

 

How Out-of-Network Therapy Billing Works at Cheerful Heart

We use Thrizer to make out-of-network care as simple and affordable as possible. Instead of paying the full session fee upfront and waiting weeks for insurance reimbursement, Thrizer verifies your out-of-network benefits and collects your estimated coinsurance (plus a 5% processing fee) at the time of your session. They handle the claim submission and work directly with your insurance, so you do not have to.

To see what your sessions might actually cost you after your insurance benefits kick in, use the calculator below.

 

 

The Bottom Line on Out-of-Network Therapy

You deserve a therapist whose loyalty is entirely to you, not to an insurance company’s bottom line. You deserve care that sees your full humanity, not just your diagnosis code. And you deserve access to that care regardless of what your bank account looks like this month.

That is the practice we are committed to building. Every intent is for the benefit of our clients, and we will always hold your well-being and access to care in mind. Out-of-network therapy can be accessible, and we partner with our clients to make sure this holds true.

Cheerful Heart is ready to meet you where you are. Book your free consultation today and let’s talk about what healing can look like for you.