If you have Cigna and you’re looking at a therapy practice that doesn’t take insurance directly, you probably still have coverage. Most Cigna plans sold in Illinois include out-of-network mental health benefits, which means the practice doesn’t need to be in Cigna’s network for you to get reimbursed. The process involves more steps than using an in-network provider, but for many people the out-of-pocket cost ends up being manageable once reimbursement comes through.
Here’s what that actually looks like in practice and what to check before you book your first session.
What “Out-of-Network Benefits” Actually Means on a Cigna Plan
When a therapist is out-of-network, they don’t bill Cigna directly. You pay the full session fee upfront, the practice gives you a document called a superbill, and you submit that to Cigna for partial reimbursement. Cigna then pays you back a percentage of what they consider the “allowable” cost for that service in your area.
The percentage Cigna reimburses varies by plan. Most PPO plans cover somewhere between 50% and 80% of that allowable amount after you’ve met your out-of-network deductible. Some Cigna plans, particularly HMOs or EPOs, don’t include any out-of-network mental health benefits at all.
Two numbers matter most when you’re reading your Cigna summary of benefits:
- Out-of-network deductible: The amount you pay out of pocket before Cigna starts reimbursing you. This resets every January 1.
- Out-of-network coinsurance: The percentage Cigna pays after you hit that deductible. If your coinsurance is 60%, Cigna covers 60% of the allowable amount and you cover the remaining 40%.
The “allowable amount” is Cigna’s internal rate for a given service code in your zip code. It’s often lower than what a private-pay therapist charges, which means your actual reimbursement check may be smaller than you’re expecting. A $200 session might have an allowable rate of $130 in Chicago, so your 60% reimbursement would be $78, not $120.
How to Find Out What Your Specific Cigna Plan Covers
Call the member services number on the back of your Cigna card and ask these questions directly:
- Does my plan include out-of-network mental health benefits?
- What is my out-of-network deductible, and how much of it have I already met this year?
- What is my out-of-network coinsurance for outpatient mental health (CPT codes 90837 and 90834 are the most common therapy codes)?
- Is there a limit on the number of outpatient mental health sessions covered per year?
- Do I need a referral or prior authorization to see an out-of-network therapist?
Write down the name of the representative you speak with and the reference number for the call. Cigna’s phone representatives don’t always give consistent answers, and having documentation matters if there’s a dispute later.
You can also log into myCigna.com, go to the “Coverage” section, and look for your mental health benefits under “Behavioral Health.” The online portal isn’t always as detailed as a phone call, but it gives you a starting point.
The Superbill Process: How Reimbursement Actually Works
At practices like Tides that operate outside of insurance networks, you’ll pay for your session at the time of the appointment. After each session, or sometimes monthly in a batch, you’ll receive a superbill. This is a detailed receipt that includes:
- Your therapist’s name and NPI (National Provider Identifier) number
- The date of service
- The CPT code for the type of session (90837 is a 53-plus-minute individual session; 90834 is a 45-minute session)
- The diagnosis code (ICD-10)
- The fee charged
You submit that superbill to Cigna either through myCigna.com under “Claims,” by fax, or by mail to the address listed on your card for out-of-network claims. Cigna typically processes out-of-network mental health claims within 30 days. Your reimbursement check goes to the address on your account, or you can set up direct deposit through the member portal.
Some clients use apps like Reimbursify or Nirvana to submit superbills automatically, which cuts down on the paperwork. Both pull your insurance information and handle the submission for a small per-claim fee.
Why People Choose an Out-of-Network Practice Anyway
The honest answer is fit. When you’re working through something real, whether that’s anxiety that’s been running your life for years, a relationship that’s breaking down, or depression that’s made it hard to function, the quality of the therapeutic relationship matters more than whether the practice is on a list.
Many in-network therapists carry caseloads of 30 or more clients and have limited availability for new patients. Out-of-network practices often have more flexibility in scheduling, session length, and the pace of treatment. At Tides, for example, we don’t work from a template. A client dealing with a first depressive episode gets a different approach than someone who’s been through multiple rounds of treatment and knows what has and hasn’t worked for them.
Out-of-network care also doesn’t mean uninsured care. Once you understand your actual reimbursement rate and factor in how much of your deductible you’ve already met, the net cost is often closer to in-network copays than it first appears. Many of our clients have their Cigna out-of-network deductible met by March or April, after which reimbursement kicks in for the rest of the year.
If cost is still a concern, it’s worth knowing what outpatient therapy for depression and anxiety can look like in terms of session frequency and overall timeline, so you can plan accordingly.
What Tides Does to Make This Easier
We provide superbills automatically after each session, formatted exactly the way Cigna requires. You don’t need to request them or track them down. If Cigna comes back with questions about a code or asks for additional clinical documentation, we handle that on our end.
We also do a benefits check before your first session if you share your insurance information during intake. We can tell you what we typically see with Cigna plans in Illinois and give you a realistic sense of what to expect, based on the allowable rates and deductible patterns we observe.
For clients who want a clearer picture of the outpatient mental health process before committing to anything, that conversation can happen during your free consultation.
FAQ
Does Cigna require pre-authorization for out-of-network therapy in Illinois?
Most Cigna PPO plans don’t require prior authorization for outpatient therapy, but some plans do. This is one of the specific questions worth asking when you call member services. If authorization is required, you’ll want to get it before your first session, not after.
How long does it take to get reimbursed by Cigna?
Cigna typically processes out-of-network mental health claims within 30 calendar days of receiving a complete superbill. If you submit digitally through myCigna.com, processing is usually faster than fax or mail.
What if Cigna denies my claim?
Claim denials are often fixable. Common reasons include a missing diagnosis code, an NPI number that needs to be verified, or a plan that requires prior authorization. Your therapist’s practice can help you understand what the denial says and whether resubmitting with additional information is likely to work. You also have the right to appeal.
Can I use my FSA or HSA to cover the upfront cost?
Yes. Therapy sessions with a licensed mental health provider qualify as a medical expense under IRS guidelines. You can pay with your FSA or HSA card directly, which covers your out-of-pocket cost while your reimbursement is processing.
Does Cigna cover couples or family therapy at an out-of-network practice?
Cigna’s coverage of couples therapy varies significantly by plan. Couples therapy is often billed under a different CPT code (90847 for family therapy with a patient present) and requires that one person in the couple has a diagnosed condition being treated. Family therapy in Chicago follows the same superbill and reimbursement process as individual therapy; the coverage question is one to confirm directly with Cigna.