Out-of-Network Therapy Reimbursement Forecaster

Forecast what your insurer will reimburse on out-of-network therapy superbills. Provide the therapist's fee, the allowed amount your plan pays, your remaining deductible, and coinsurance percentage to see how much applies to the deductible, what the insurer reimburses, and how many visits remain before benefits fully activate.

What you pay the therapist per session before insurance reimbursement.
Maximum reimbursable amount your plan recognizes for the service code.
Portion of your out-of-network deductible left before coinsurance applies.
Percent of the allowed amount you still owe once the deductible is satisfied.

Results assume prompt claim approval without coordination-of-benefits adjustments. Verify exact reimbursement schedules with your insurer.

Examples

  • $220 session, $150 allowed, $800 deductible left, 30% coinsurance ⇒ The next claim applies $150.00 to your deductible, leaving $650.00 outstanding. No reimbursement yet, so you pay the full $220.00. Expect roughly 6 visits at this rate before coinsurance-level benefits kick in.
  • $180 session, $160 allowed, $0 deductible, 20% coinsurance ⇒ With the deductible met, $160.00 is eligible for reimbursement and the plan should pay $128.00. Your out-of-pocket drops to $52.00 for that session.

FAQ

How do I find the allowed amount for my plan?

Call your insurer with the CPT code, provider zip code, and provider type to confirm the maximum reimbursable amount before submitting claims.

What if my therapist's fee is higher than the allowed amount?

The calculator still assumes you pay the full fee. Only the allowed portion counts toward the deductible and reimbursement, so any difference stays out-of-pocket.

Do superbills count toward my in-network deductible?

Most plans track out-of-network deductibles separately. Enter the balance from your out-of-network accruals to match how the insurer applies payments.

Can I include multiple sessions at once?

Use the allowed amount and deductible remaining before the next batch of claims. After reimbursement posts, update the deductible balance and rerun the forecast.

Additional Information

  • Allowed amounts cap what the insurer considers when determining reimbursement and deductible credits.
  • Coinsurance percentages reflect the share you owe after satisfying the deductible; enter 0% if the plan reimburses 100%.
  • The visit counter assumes each future session is billed at the same allowed amount.
  • Provider charges above the allowed amount remain your responsibility even when reimbursement begins.

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