When you’re offering out-of-network benefits to clients, one question tends to come up again and again: How much will I actually get reimbursed?
And at the heart of that question is a concept many clients (and even some therapists) aren’t familiar with — the allowed amount.
The allowed amount is the number the insurance company uses as the basis for reimbursement. It’s what they consider a fair or “usual” rate for a specific service — not necessarily what you charge.
For example, let’s say you charge $200 for a 50-minute session. If the insurer’s allowed amount is $180 and the client has 80% out-of-network coverage, they’d be reimbursed $144 (80% of $180), not 80% of the full $200.
Not necessarily — and this is key to understand. While allowed amounts are determined internally by each insurance company and aren’t publicly available, they’re often in the same ballpark as what providers charge, especially in urban areas or when clients are working with specialized therapists.
In our data at Mentaya, we’ve seen that for many clients, the allowed amount is relatively close to the therapist’s actual fee — though of course, it can vary depending on plan details and location. The important part is: reimbursement is often meaningful, and clients using Mentaya are routinely getting 60–80% of their session cost back.
When clients understand how reimbursement works — and when they feel confident they’ll get a solid portion of their costs back — they’re more likely to commit to working with you long-term, even if you're out-of-network.
That’s why Mentaya takes care of the heavy lifting. We help:
The result: You get paid your full rate. Your clients get to use their benefits. Everyone wins.
Helping your clients use their out-of-network benefits shouldn't require becoming an insurance expert. With Mentaya, you can confidently support reimbursement — without compromising your rate or adding admin overhead.
