Guide to Zencare’s Out-of-Network Therapy Cost Estimate Tool

You may often first try to find therapists who are in-network with their insurance; however, you may find your results to be limited, as in-network therapists tend to be fully booked. In these cases, it can be beneficial to consider expanding your search to include out-of-network therapists as well. A therapist is out-of-network if they don't have an agreement with your health insurance company and set their own fees. When you see an out-of-network therapist, you pay the full session fee at each appointment.

The good news is that many insurance plans also include out-of-network benefits that can cover all or some of the cost of therapy sessions. These out-of-network benefits can make seeing an out-of-network provider more affordable: you see the therapist, pay your therapist for the session, submit reimbursement (this can be done digitally using a tool like Reimbursify), and your insurance company will send you a check with the reimbursement amount.

Want to know if your health insurance offers out-of-network coverage for therapy? Learn about Zencare’s Out-of-Network Cost Estimate tool, which can help you find out this information!

What is the Zencare Out-of-Network Cost Estimate?

The Zencare out-of-network Cost Estimate is a tool that calculates what therapy will likely cost if you use your health insurance plan’s out-of-network benefits to receive reimbursement for part of your therapy session.

Input your name, health insurance ID, and date of birth, and we’ll check whether you have out of network benefits for therapy sessions!

The Zencare Out-of-Network Cost Estimate tool can help you quickly assess whether and how much your health insurance plan covers out-of-network therapy sessions.

How do I use the Zencare Out-of-Network Cost Estimate tool?

Using Zencare’s Out-of-Network Cost Estimate tool is easy, begin by creating a Zencare client account. Please note that the Cost Estimate tool is intended to aid therapy seekers in finding their best fit therapist by exploring out-of-network options — Zencare does not set the pricing or fees of therapists, and Zencare does not handle billing or other charges for therapy seekers.

1. Sign up for a free Zencare client account.
2. Once you are logged into your account, visit the search page in your state. Click on the “Check Cost Estimates” button at the top of the page, or on a provider card.
3. Fill out the information required and click “Next.” Our tool will run your information and let you know if you have out-of-network therapy benefits!
4. On the search page, you’ll see session estimates for out-of-network providers, along with an indication of which providers are in-network with your health insurance plan (they’ll have a green “In-Network” badge).
5. In some cases, you may get a result that says we aren’t able to verify whether your health insurance plan offers reimbursements for out-of-network therapy. Don’t be alarmed if this is what you see! We still encourage you to continue your search for a therapist in your network. You can do this by selecting your insurance provider from the Insurance filter drop down. You can also filter your search by Session Fee, or look at therapists that offer a sliding scale.

I have my estimate — now what?

Congratulations! You now have an estimate that can be used to guide your decision-making in reaching out to an out-of-network therapist. If the range provided to you works for your budget, and you find out-of-network providers that meet your criteria — reach out to them for a free consultation to see if you’d be the right fit!

When you reach out to a therapist, you may also be able to confirm with them the exact details of the Out-of-Network Cost Estimate you received, as well as other details like your deductible and how much of it you’ve met so far. You’ll get a better idea of what each session with that therapist would cost, and how much you could expect to be reimbursed for.

While the data on Zencare is pulled from health insurance companies’ databases, they are not a guarantee of coverage. For ultimate accuracy, we always recommend confirming your benefits by calling your insurance company. Here are steps you can take to verify your coverage with your insurance company!

How do I get reimbursed for out-of-network therapy sessions?

To get reimbursed for out-of-network therapy sessions, pay the therapist's full fee after the session, ask for a superbill, and submit a claim to your insurance company. Within a few weeks, you should receive a reimbursement check in the mail!

A superbill can be thought of like a receipt or invoice for all of your sessions that you can use to submit claims to your insurance company for reimbursement. Your therapist may send this to you on a monthly or more frequent basis.

Claims can be filed with your insurance company through snail mail or the insurance’s online portal. You can also use an app like Reimbursify to facilitate this electronically and receive the reimbursable amount via check.

Some therapists will submit out-of-network claims to your insurance on your behalf, so you don’t have to do any paperwork. Ask your therapist about this option as well!

Frequently Asked Questions

Do I need to create an account to use this tool?

• Yes, if you would like to use the Cost Estimate tool you will need to create a Zencare Client account. You can create one here. It is completely free to create a Zencare account, use our directory, use the Cost Estimate tool, and reach out to therapists for a consultation!

Why do some therapists have a “check cost estimate” badge and others don’t?

• The Cost Estimate tool is optional for therapists to add to their profile. Some therapists have not opted-in to adding this tool to their profile. You can still reach out to any therapist that you’re interested in, regardless of if they have this tool!

Where can I get an estimate of my out-of-network costs?

• You can get an estimate of your out-of-network costs by using our Cost Estimate tool. There is a “Check Cost Estimate” button that you can click at the top of our directory’s search, on a therapist in your search results, or on a therapist’s profile.

Is it free for me to get an estimate?

• Yes! It is free for you to get an estimate.

What if I accidentally fill out my insurance information wrong?

• No worries! If you filled out your insurance incorrectly while using the Cost Estimate tool, one of the pop-ups will show a “Change” option (example below) — this will bring you back to your Zencare Account where you can update your insurance details.