If a therapist is “in-network” with an insurance company, they have agreed to accept the rate an insurance company is willing to pay per session. When a therapist is in-network with your insurance, you pay them a set portion of the session fee, or “copay” after each session, and the insurance company pays the remainder.
If a therapist is “out-of-network,” the therapist has not contracted with the insurance company and you're responsible for paying the full session fee upfront. However, many insurance plans have “out-of-network benefits,” meaning that after you pay the session fee, you submit a claim to the insurance company, and they'll mail you a check to reimburse a portion of the cost. The amount you can get reimbursed varies greatly by insurance company and plan, ranging from 20% - 80%.