Using insurance for therapy in PA and NJ: deductibles, copays and superbills, explained simply
Reviewed and updated August 2026.
The short answer: yes. If you have health insurance in Pennsylvania or New Jersey, it almost certainly covers therapy. Federal parity law requires health plans that offer mental health benefits to cover them comparably to medical care. What you will actually pay comes down to four numbers on your plan, and at Turning Leaf, where we are in-network with Aetna, United Healthcare and Optum, Highmark BCBS, Capital Blue Cross, Anthem, Empire and FEP BCBS, and Horizon BCBS NJ, most clients land at a $15 to $50 copay per session after deductible.
This guide explains those four numbers in plain English, walks the math with real examples, and gives you word-for-word scripts for calling your insurer. And if you would rather not do any of it: tell our intake team your plan, and we verify your benefits for free before your first session.
The four words that decide what you pay
- Premium is what you or your employer pay monthly just to have the plan. Already spent; ignore it for therapy math.
- Deductible is what you pay out of pocket each plan year before insurance starts sharing costs. Until it is met, you pay your plan’s negotiated rate per session, which is usually less than a practice’s self-pay price.
- Copay is a flat fee per session once your deductible is met. This is where most of our in-network clients live: $15 to $50.
- Coinsurance is the alternative some plans use, a percentage of the session rate rather than a flat fee, often around 20 percent.
One important wrinkle: some plans skip the deductible for outpatient mental health entirely and charge you just the copay from session one. This single detail changes your first-month costs more than anything else, and it is question two in the phone script below.
The math, walked through twice
Sarah, on a copay plan
You may remember Sarah from our Philadelphia therapy cost guide: Aetna, a $1,500 deductible, a $30 mental health copay. Early in the plan year she pays Aetna’s negotiated session rate until she has spent $1,500 across all her health care. After that, therapy is $30 a session, every session.
Marcus, on a coinsurance plan
Marcus has a plan with a $1,000 deductible and 20 percent coinsurance. After meeting his deductible, if his plan’s allowed rate for a session is $120, Marcus pays $24 and his plan pays the rest. Same logic, a percentage instead of a flat fee.
Both examples are illustrative. The only numbers that matter are yours, which is exactly what a benefits check tells you before you commit to anything. Whether you are starting anxiety therapy or deeper trauma work, the billing works the same way.
Why your card says a name you have never heard
Many plans carve out mental health benefits to a partner company. The classic example: your medical card says UnitedHealthcare, but your therapy benefits run through Optum. Nothing is wrong. It is the same coverage under a different administrator, and it is why the behavioral health number on the back of your card is the one that matters for therapy questions. We are in-network on the Optum side, which is what counts for UHC members. There is more on network confusion in our guide to finding a therapist who takes your insurance.
Is my plan actually required to cover therapy?
In almost all cases, yes. The federal Mental Health Parity and Addiction Equity Act requires plans that offer mental health benefits to cover them comparably to medical care, with no harsher session limits, copays, or approval hurdles than you would face for physical health. Pennsylvania and New Jersey plans also generally cover telehealth therapy on par with in-person care, which is how our clients see us from anywhere in either state.
What parity does not do is set your copay or erase your deductible. It guarantees fairness, not a price. The price is those four numbers above.
Turning Leaf is in-network with Aetna, United Healthcare and Optum, Highmark BCBS, Capital Blue Cross, Anthem, Empire and FEP BCBS, and Horizon BCBS NJ. Typical copay $15 to $50 after deductible. We are not in-network with Independence Blue Cross, Cigna, Medicare, or Medicaid; superbill reimbursement is explained below. Full session rates are on our rates page.
Out-of-network, explained without the runaround
If your plan is not on our list, here is the honest version of how out-of-network reimbursement works:
- You pay the session rate, $130 to $200 depending on the clinician’s license level.
- We give you a superbill, an itemized receipt with the diagnosis, service, and CPT codes insurers require.
- You submit it to your plan. If your plan has out-of-network mental health benefits, and many PPOs do, it reimburses a percentage of its allowed amount after you have met your out-of-network deductible.
Two honest caveats. The allowed amount may be lower than the session price, so 70 percent back means 70 percent of their number, not ours. And Medicare and Medicaid generally cannot be reimbursed through superbills; their out-of-network rules are much stricter than commercial plans. If that is your coverage, ask our intake team about your options rather than counting on reimbursement. The insurance page lays out every plan we take.
Exactly what to say when you call your insurer
Call the behavioral health number on the back of your card and read these off. The rep may transfer you, which is normal.
Script A, if we are in-network with your plan
- “Do I have outpatient mental health benefits for office and telehealth visits?”
- “Does my deductible apply to outpatient mental health, or do I just pay the copay?”
- “What is my copay or coinsurance per session?”
- “How much of my deductible is already met this year?”
- “Do I need a referral or prior authorization for outpatient therapy?” Usually no, but two minutes now beats a surprise later.
Script B, if we are out-of-network
- “Do I have out-of-network outpatient mental health benefits?”
- “What is my out-of-network deductible, and how much is met?”
- “What percentage of the allowed amount do you reimburse for CPT code 90837, a therapy session?”
- “How do I submit a superbill, and how long does reimbursement take?”
Write the answers down with the date and the rep’s name. Or skip the call entirely: tell us your plan and our intake team runs the check for you before your first session.
Paying with pre-tax dollars (HSA and FSA)
Psychotherapy is generally an HSA and FSA eligible expense, covering copays, self-pay sessions, and out-of-network balances alike. For many people that is an effective 20 to 30 percent discount, using money you have already set aside. Check with your plan administrator; no special paperwork is usually needed.
The diagnosis question, and your privacy
Insurance pays for treatment of a condition, so in-network billing requires a diagnosis code from your therapist. That code appears in your insurance records and on your Explanation of Benefits, the summary your insurer mails or posts after each claim. Superbills carry the same codes. Your therapist will discuss any diagnosis with you openly; nothing goes on paper that has not been talked about in the room.
One situation deserves plain speech. If you are on someone else’s policy, a parent’s or a spouse’s, the policyholder can typically see Explanations of Benefits, which show that visits occurred, though not what was said. Your session content is confidential either way. If billing privacy is a real concern for your situation, tell our intake team. Options exist, including self-pay, and we would rather solve it with you upfront.
Getting started
Reach out using the button below or call 215-399-4128. Forms sent tonight are answered first thing the next business day.
A real person verifies your benefits, including deductible status, copay, and telehealth coverage, and tells you your expected cost per session.
You are matched with one of our clinicians at our Old City office, 123 Chestnut Street, Suite 304, or via telehealth anywhere in Pennsylvania and New Jersey. After your intake form, a coordinator reviews it and verifies your benefits; most people have a first session within about a week.
Frequently asked questions
Does insurance cover online therapy in Pennsylvania and New Jersey?
Generally yes, on par with in-person sessions, with the same copays and benefits, for the in-network plans we accept across both states.
Is a diagnosis required for insurance to pay for therapy?
For in-network billing, yes. A diagnosis code accompanies each claim. Your therapist discusses it with you transparently, and it never includes session content. Self-pay is the alternative if you would rather keep insurance out entirely.
My deductible is huge. What are my options?
Ask question two from Script A first, because many plans charge only the copay for mental health and leave the deductible untouched. If yours does not, negotiated in-network rates are lower than sticker price, HSA and FSA dollars help, and associate-level clinicians start at $130. Our cost guide walks through all five levers.
Does Medicare or Medicaid cover therapy?
Both cover outpatient mental health care with participating providers. Turning Leaf is not in-network with either, and their rules generally do not allow superbill reimbursement, so if you carry Medicare or Medicaid, tell our intake team and we will be straight about whether we are a workable fit before you invest time.
I am on my parents’ insurance. Will they know I am in therapy?
The policyholder can typically see Explanations of Benefits showing that visits occurred, never what you talked about. If that is a barrier, raise it with our intake team; between plan-privacy options and self-pay rates, there is usually a path.
Turning Leaf Therapy at a glance: depth-oriented, trauma-informed therapy in Old City, Philadelphia, at 123 Chestnut Street, Suite 304, and via secure telehealth across Pennsylvania and New Jersey. In-network with Aetna, United Healthcare and Optum, Highmark BCBS, Capital Blue Cross, Anthem, Empire and FEP BCBS, and Horizon BCBS NJ, with typical copays of $15 to $50 after deductible. Not in-network with Independence Blue Cross or Cigna; superbills provided. Free benefits verification before your first session. Call 215-399-4128.
This article is educational and is not a substitute for professional care or individualized insurance advice; always confirm benefits with your plan. If you are in crisis or thinking about harming yourself, call or text 988, the Suicide and Crisis Lifeline, text HOME to 741741 for the Crisis Text Line, or go to your nearest emergency room.