If you’ve been meaning to start therapy “once things calm down,” the last two months of the year may be the most affordable time you’ll get. Two benefits quietly expire on December 31 for most people: unspent money in a health Flexible Spending Account (FSA), and the progress you’ve already made toward your insurance deductible.
At Denver Wellness Counseling, many of our clients see us out of network. They chose a specific, experienced therapist over whoever happened to be on an insurance list. That choice is often more affordable than people expect, especially in the fourth quarter. This guide walks through how FSAs, HSAs, and out-of-network benefits work, why timing matters, and exactly what to ask your insurance company before the year ends.
You don’t need to be a benefits expert. You just need about 20 minutes, your insurance card, and a few questions written down.
Your FSA: Use It or Lose It
A health FSA lets you set aside pre-tax money from your paycheck for medical expenses. Because that money is never taxed, every dollar goes further, often 20 to 35 percent further depending on your tax bracket.
The catch is the deadline. FSA money generally has to be spent within the plan year, and most plan years end December 31. Whatever is left over beyond your plan’s allowance is forfeited to your employer.
A few numbers worth knowing for 2026:
Contribution limit: up to $3,400 per employee for plans starting in 2026, up $100 from 2025.
Carryover: if your employer offers it, you can roll up to $680 of unused 2026 money into 2027. Your employer can set a lower cap, or offer none at all.
Grace period instead of carryover: some plans give you until mid-March to spend last year’s money. A plan can offer a carryover or a grace period, but never both.
So if you have $1,200 left in your FSA and your plan carries over $680, the remaining $520 disappears on January 1 unless you use it. That’s roughly three therapy sessions.
Is therapy an eligible FSA expense? Yes. Psychotherapy with a licensed mental health professional is a qualified medical expense. It doesn’t matter whether your therapist is in or out of network with your insurance. Many FSA cards work like a debit card at the time of your session; otherwise you pay and submit your receipt for reimbursement.
One important detail: the session has to happen in the plan year. Prepaying in December for sessions in February usually doesn’t count. The money is tied to the date of service, not the date of payment.
What If You Have an HSA Instead?
A Health Savings Account (HSA) is a different animal, and it’s good news. HSA money never expires. It rolls over year after year and stays with you if you change jobs. For 2026, the HSA contribution limit is $4,400 for individual coverage and $8,750 for family coverage.
That means there’s no year-end deadline to spend an HSA. But there are still two reasons to think about therapy now:
You can still use it for therapy. Like an FSA, an HSA covers psychotherapy, in or out of network, with pre-tax dollars.
HSAs come with high-deductible health plans. If you’re on one, the deductible clock below matters even more for you.
Not sure which you have? Look at your benefits portal or the card itself. If it says “FSA,” the December deadline applies. If it says “HSA,” your balance is safe, but read on.
How Out-of-Network Benefits Actually Work
“Out of network” sounds like “not covered.” For many people with PPO or POS plans, it isn’t. It means your insurance covers the care differently.
Here’s the usual sequence:
You pay your therapist directly at the time of your session.
Your therapist gives you a superbill. This is a detailed receipt with the diagnosis code, the service code, dates, fees, and the provider’s license and tax ID. It’s everything your insurance company needs.
You submit the superbill to your insurer, usually through an online portal or app. Some practices use services that submit claims for you automatically.
Your insurer reimburses you a percentage of what it considers the “allowed amount” for that service, once your out-of-network deductible is met.
Three terms to understand:
Out-of-network deductible: what you pay before reimbursement starts. This is often separate from, and higher than, your in-network deductible.
Coinsurance: the percentage your plan pays after the deductible, commonly 50 to 80 percent.
Allowed amount: the rate your insurer decides is reasonable for the service. It may be lower than your therapist’s fee, so your reimbursement is based on that number, not the full fee.
HMO and EPO plans usually have no out-of-network coverage. Even then, your FSA or HSA can still pay for sessions.
Why Your Deductible Makes November and December Special
Most deductibles reset on January 1. If you’ve had a big medical year (a surgery, a new baby, an injury, a hospital stay), you may have already met some or all of your deductible. That’s the window.
Once your deductible is met, out-of-network therapy can be reimbursed right away, for the rest of the year. On January 1, the meter goes back to zero.
An example. Say your therapist charges $180 per session and your plan reimburses 60 percent of an allowed amount of $150 once your deductible is met.
Deductible already met: you get back about $90 per session. Your real cost is roughly $90. If you pay that $90 from your FSA, you’re paying with pre-tax money too.
Deductible not met: you get nothing back yet, but each session counts toward the deductible until it resets.
(These numbers are for illustration only. Your plan’s allowed amount and coinsurance will differ.)
Also check your out-of-pocket maximum. If you’ve hit it, some plans reimburse eligible out-of-network care at 100 percent of the allowed amount for the rest of the year. Ask whether your plan has a separate out-of-network maximum.
To be honest about the other side: if you haven’t touched your out-of-network deductible this year, December sessions probably won’t be reimbursed, and that progress resets in January. In that case, your FSA balance is the bigger opportunity, and starting now still gives you a head start on the work itself.
Your End-of-Year Checklist
Step 1: Check your FSA balance and rules. Log into your benefits portal and note:
Your current balance
Your plan year end date (usually December 31, but not always)
Whether you have a carryover, a grace period, or neither
The claims deadline for submitting receipts (often 60 to 90 days after the plan year ends)
Step 2: Call your insurance company. Use the member services number on the back of your card and ask about outpatient mental health, out of network. Write down the answers and the representative’s name.
Do I have out-of-network benefits for outpatient psychotherapy?
What is my out-of-network deductible, and how much have I met this year?
When does my deductible reset?
What percentage do you reimburse after the deductible?
What is the allowed amount for CPT code 90837 (a 53+ minute session) and 90834 (a 38 to 52 minute session)?
Is prior authorization required?
How do I submit a superbill, and how long does reimbursement take?
What is my out-of-network out-of-pocket maximum, and how much have I met?
Step 3: Do the math. Compare your FSA balance, your remaining deductible, and the number of weeks left in the year. Weekly sessions from early November through December is about 7 or 8 sessions.
Step 4: Book a consultation soon. Therapists’ calendars fill up in November and December, and holidays shorten the weeks. A free consultation now protects your spot.
Step 5: Keep your paperwork. Save every superbill and receipt. Your FSA administrator may ask for documentation, and some request a letter confirming therapy is treating a medical condition.
For Colorado Residents: A Few Extra Things to Know
If you’ve struggled to find a therapist in your network, you’re not alone. Colorado lawmakers have cited figures showing Coloradans are roughly 9 to 11 times more likely to go out of network for behavioral health care than for comparable physical health care (Colorado House Democrats).
The state has been working on it:
HB25-1002, in effect since January 1, 2026, requires state-regulated insurers to use nationally accepted, evidence-based criteria when deciding whether mental health care is medically necessary (Becker’s Payer Issues).
HB26-1002, in effect since August 12, 2026, targets “ghost networks” (directory listings for therapists who aren’t actually available) and speeds up credentialing for mental health providers (Colorado House Democrats).
What this means for you: if your plan can’t connect you with an in-network therapist who has openings and the right specialty, ask your insurer whether it will cover an out-of-network provider at in-network rates. This is sometimes called a network gap exception or single case agreement. Document every call and every provider you tried.
One caveat: Colorado insurance laws generally apply to state-regulated plans. Many large employers have “self-funded” plans governed by federal law instead. Your HR department or the back of your card can tell you which you have.
Is Out-of-Network Therapy Worth It?
Using insurance makes sense, especially when premiums are already high. Plenty of people find great care in network. Choosing out of network is simply about having more say in who you work with.
For some people, that matters a lot. If you’re carrying trauma, burnout, or anxiety that hasn’t budged with past attempts, the fit and experience of your therapist can shape how quickly things change. Seeing someone out of network means you can choose based on specialty and approach, rather than on who has an opening in a directory.
It can also mean more focused care. When a therapy plan is built around your goals instead of what an insurer will authorize, sessions can build on each other with a clear direction.
How We Help at Denver Wellness Counseling
Our therapists in Golden and Denver’s LoHi neighborhood specialize in trauma, PTSD, EMDR, anxiety, and burnout for adults and professionals. We aim to make the financial side as clear as the clinical side:
Transparent fees. Individual sessions range from $165 to $200 per 50-minute session, depending on the therapist. See our rates and payment options.
We accept HSA and FSA cards.
Superbills provided so you can submit for out-of-network reimbursement.
A plan from the start. Within your first couple of sessions, you and your therapist map out what you’re working on and how you’ll know it’s helping. See what that can look like.
Good Faith Estimates. Under the federal No Surprises Act, if you’re paying privately you have the right to a written estimate of expected costs. We’re happy to provide one.
Ask about options. We hold a limited number of reduced-fee spots and accept Colorado victim compensation. If cost is the barrier, talk with us before deciding.
Ready to use your benefits before they reset? Schedule a free consultation and we’ll help you think through your options, including what to ask your insurance company. The sooner you reach out, the more weeks you’ll have before December 31.
This article is for general information only and isn’t tax, legal, or insurance advice. Benefits vary widely by plan. Confirm details with your insurer, FSA/HSA administrator, or a tax professional.
