An out-of-pocket cost is the amount a client must pay themselves for healthcare rather than having the insurer pay it. Depending on the plan and service, this may include a deductible, copay, coinsurance, a non-covered service, or the portion of a provider’s fee that the plan does not reimburse.
For out-of-network therapy, the client’s out-of-pocket cost can be different from the amount initially paid to the therapist. If reimbursement is available, the client may pay the full fee first and receive a partial payment later. Estimating the likely cost requires understanding the plan’s out-of-network benefits and how the insurer calculates its share.