How to Use Your PPO Insurance for Therapy (Cigna, Aetna, Anthem & More)
- 10 hours ago
- 3 min read
If you’ve been looking for a therapist and keep seeing “out-of-network,” you’re probably wondering one thing:
Is this actually going to be affordable with my insurance?
Especially if you have a PPO plan through Cigna, Aetna, or Anthem Blue Cross of California, the answer is often yes—but it depends on a few key details that most people aren’t told upfront.
This guide will walk you through what therapy really costs with out-of-network benefits, and how to figure out what your plan will actually reimburse.
Why many therapists are out-of-network
A lot of specialized therapy—especially when it comes to intimacy, relationships, and sex therapy—is offered out-of-network.
This allows for:
• More flexibility in how we work together
• More privacy (less diagnosis-driven care)
• The ability to focus on depth and nuance instead of insurance limitations
Instead of billing insurance directly, you pay for sessions and receive a superbill, which you can submit for reimbursement.
What “out-of-network reimbursement” actually means
If you have a PPO plan, your insurance may reimburse you for a portion of each session.
Most plans work like this:
• You have a deductible (a set amount you pay before insurance starts contributing)
• After that, your plan reimburses a percentage (often 70–80%)
• This percentage is applied to something called the allowed amount
This is the part most people don’t realize:
Insurance doesn’t base reimbursement on what you pay—it’s based on what they consider a “reasonable” rate.
What this looks like in real life
Let’s say your session fee is $240.
If your plan’s allowed amount is $220 and your reimbursement rate is 70%:
• Insurance pays: $154
• You pay: $86
For many clients with PPO plans through Cigna, Aetna, or Anthem, sessions often end up in the range of:
✨ $60–$100 per session after reimbursement (once your deductible is met)
That’s why understanding your specific plan matters—it can change the experience completely.
The 3 things that determine your reimbursement
If you take nothing else from this, it’s these:
1. Your deductible
If it hasn’t been met yet, you’ll pay the full session fee until it is.
2. Your reimbursement rate
Usually between 60–80% for PPO plans.
3. The allowed amount
This is the biggest factor and varies by insurance plan.
Plans through Cigna, Aetna, and Anthem Blue Cross (California) tend to have higher allowed amounts, which is why many clients with these plans receive more meaningful reimbursement.
How to check your benefits (quickly)
You can call the number on the back of your insurance card and ask:
• Do I have out-of-network mental health benefits?
• What is my deductible, and how much has been met?
• What is my reimbursement rate for outpatient therapy?
• What is the allowed amount for CPT code 90837?
If you’d rather not deal with that, I can help you walk through it.
What to expect when working together
I provide a superbill after each session, which you can submit to your insurance for reimbursement.
Many of my clients use PPO plans through Cigna, Aetna, or Anthem and receive partial reimbursement for sessions, especially once their deductible has been met.
If you’re not sure where your plan falls, we can figure that out together. I even have a video on the website under “Fees” that explains this more.
Not sure if your plan will work?
If you want help understanding your specific insurance before committing, you can fill out my contact form here:
We can go over:
• Your benefits
• What sessions would realistically cost
• Whether this feels like a sustainable fit for you
Final thoughts
Therapy is an investment, but it shouldn’t feel confusing or opaque to access.
If you already have a PPO plan, there’s a good chance you have more support available than you think—you just need to know how to use it.
by Maddie Hundley, LMFT
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