Out of Network Costs Calculator (For when your therapist's fee is lower than your Amount Allowed)
This calculator will help you make an estimate of your Out-of-Network costs for psychotherapy specifically when your therapist's fee is lower than your Amount Allowed. I made a separate calculator for this, as it required a different formula to do the math more accurately and efficiently. Filling it out does not constitute financial advice, nor a formal therapeutic relationship. This is simply a tool to help you visualize these costs over the course of months to a year. To review, you need three pieces of information for this calculator, which you can get by calling your insurance directly (the member services number is usually in the back of your insurance card). You need to ask your insurance for your Out-of-Network
- Deductible: The yearly amount you pay before your insurance begins covering costs.
- Coverage: The percentage your insurance pays after you meet the deductible.
- Allowed Amount : The maximum amount your insurance will pay per visit, or apply to your deductible.
BE SURE TO FOLLOW THESE INSTRUCTIONS:
- If the fee you want to calculate is equal to or lower than your Allowed Amount, you can use the calculator below.
- If the fee you want to calculate for is higher than your Allowed Amount, I created a separate calculator with specific formulas for that scenario here. If you enter those numbers in the calculator below the estimate will be inaccurate.
Basic Assumptions of this Calculator
Curious about how I came up with these calculations for the estimate? Given that there can be many variables in play, we made a few assumptions to simplify things. For the purpose of these calculations, we assume
- you and your therapist won't see each other for at least two and a half months--or 10 weeks--out of the year, to account for sick days, vacation time, and holidays (you need R&R as much as we do!).
- your deductible "resets" at the end of the calendar year (some people's deductible resets in the middle of the year, such as May or August).
- you are starting therapy within the first third of the year (in order to keep the calculations as simple as possible). Obviously, if you start later in the year, and thus have less sessions, the cost would be smaller.
- that there are no major changes to your insurance over the course of the year.
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