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Insurers reimburse a percentage of their own "allowed amount," often far below big-city mental health fees.

Out-of-network deductibles are separate from in-network deductibles, and typically higher.

Under the No Surprises Act, you're entitled to a written Good Faith Estimate before scheduled care.

A few plans, including some New York State employee plans, carry unusually strong out-of-network benefits.

A patient pays $500 for a psychiatric visit. Her plan documents say it covers 70 percent of out-of-network care. The reimbursement check arrives for $140.

That check is correct. The plan worked exactly as designed. I'm a psychiatrist, and I walk patients through this arithmetic often enough that I think the design deserves a plain-language explanation, because the gap between what people expect back and what they receive is one of the most common sources of frustration in private mental health care. It's better understood before your first appointment than after your first claim.

The Number You Never See

When a plan says it covers 70 percent of out-of-network care, most people reasonably read that as: I pay $500, I get $350 back.

Insurers don't reimburse a percentage of what you were charged. They reimburse a percentage of what they've internally decided the service should cost. That figure goes by several names, including the allowed amount, UCR (usual, customary and reasonable), or MRC (maximum reimbursable charge).........

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