Using Insurance for Therapy
Sag Aftra OUT-OF-NETWORK
We help clients use their out-of-network insurance benefits to cover the cost of therapy.
If you have SAG AFTRA insurance, you most likely have out-of-network benefits. You also mostly likely do not need pre-approval for a 45 or 60 minute psychotherapy session, and there is no limit to the amount of sessions you can have in a year.
Sag Aftra will typically cover 80% of their customary rate or allowed amount for out-of-network coinsurance reimbursements. While some plans set the allowed amount at an artificially low rate ($83 for a 45 minute meeting), other plans use the usual and customary rate ($275 for a 45 minute meeting, and $310 for a 60 minute meeting). To find out what the allowed amount for your specific plan is, please speak to your insurance company.
Here’s an example of what this looks like using the Fair Health Consumer website to calculate expenses for a 45-minute session. This is a useful tool to provide you with an estimate of your healthcare expenses.
80% of the usual and customary fee means that they will pay $220 of a $275 fee, making the out of pocket cost $55 after reimbursement.
We have also seen out-of-network deductibles range from $500 – $1,000 depending on the plan.
To receive an approximate estimate of what you can expect to pay for therapy, enter your information into our Insurance Benefits Calculator. You can download and email us this information and we will cross-verify your benefits on your behalf.