How to Afford Fat Liberation Therapy: A Guide to OON Benefits & State Health Plan

How to Afford Fat Liberation Therapy: A Guide to Out-of-Network Benefits & State Health Plan Coverage

Finding a therapist who truly understands Fat Liberation—someone who won’t secretly judge your body or suggest weight loss as a “cure” for your anxiety—can feel like finding a needle in a haystack.

When you finally find them—perhaps at a specialized practice like Winter to Spring Wellness in Asheville or a boutique provider in Charlotte—you might hit a second wall:

“I am an Out-of-Network Provider. My rate is $175 per session.”

For many North Carolinians, this is the moment they close the browser tab. The sticker shock is real. But here is the secret that insurance companies don’t go out of their way to tell you: The sticker price is rarely what you actually pay.

If you have a PPO plan (like Blue Cross Blue Shield of NC or the State Health Plan), you likely have a hidden bank account of benefits called “Out-of-Network” (OON) coverage. Using these benefits can bring the cost of a specialist therapist down to roughly the same price as a standard copay.

This guide is your financial roadmap. We will decode the insurance jargon, explain the “Superbill” hack, and specifically break down how NC State Employees (teachers, university staff) can maximize their benefits for weight-inclusive care.

1. The “In-Network” Trap vs. The Specialist Reality

First, it is important to understand why so many Fat Liberation and Eating Disorder specialists in North Carolina do not take insurance directly.

It is not because they are greedy. It is often an ethical stance against the Medical Industrial Complex.

Why “Liberation” Providers Go Private Pay

1. Pathology vs. Humanity: To bill insurance directly, a therapist must give you a diagnosis (like Major Depressive Disorder) within the first session. Fat Liberation therapists often reject the medical model that pathologizes your existence. They want to treat you, not a code.
2. Restrictions on Care: Insurance companies often limit the number of sessions or dictate what type of therapy is “medically necessary.” A reviewer at an insurance desk might decide that because your BMI hasn’t changed, therapy isn’t “working”—a direct conflict with HAES® principles.
3. Sustainability: Insurance reimbursement rates for mental health in NC have historically been low. To stay in-network, therapists often have to see 30+ clients a week, leading to burnout. Private pay allows them to see fewer clients (e.g., 15-20) and provide higher quality, specialized care.

The Trade-Off: You pay more upfront, but you get a provider who works for you, not the insurance company.

2. Insurance Dictionary: The 4 Terms You Need to Know

Before you call your insurance company, you need to speak their language. Here is your cheat sheet.

1. Deductible

This is the amount you must pay out-of-pocket before your insurance starts chipping in.

• Note: You usually have two deductibles: one for In-Network and one for Out-of-Network. They are separate buckets.

2. Co-insurance

Once you meet your deductible, this is the split you share with the insurance company.

• Common NC Split: 70/30. This means the insurance pays 70%, and you pay 30%.

3. Allowed Amount

This is the tricky one. This is the maximum amount your insurance thinks a therapy session should cost.

• Example: Your therapist charges $175. Your insurance says the “Allowed Amount” for that zip code is $120. They will only reimburse you 70% of their number ($120), not your number ($175).

4. Superbill

This is a specialized receipt your therapist gives you. It contains all the medical codes (CPT and Diagnosis) the insurance company needs to process your claim.

3. The Math: A Real-World Example

Let’s look at a hypothetical scenario for a client in Raleigh with a standard Blue Cross NC PPO plan.

• Therapist Rate: $175 per session.
• Insurance Plan: 70% OON coverage after a $1,000 deductible.
• Allowed Amount: $140.

Phase 1: The Deductible (The First ~6-8 Sessions) You pay the full $175. You submit the Superbill. The insurance pays you $0, but they credit $140 toward your $1,000 deductible.

• Result: After about 7 sessions, you have met your deductible.

Phase 2: The Reimbursement (The Rest of the Year) You pay the therapist $175. You submit the Superbill.

• Insurance calculates 70% of the $140 allowed amount = $98.
• Insurance mails you a check for $98.
• Your Real Cost: $175 (paid) – $98 (reimbursed) = $77 per session.

The Verdict: While $77 is more than a $30 copay, it is significantly less than $175. It makes seeing a top-tier specialist accessible for many middle-class families.

4. Deep Dive: The NC State Health Plan (SHP)

If you are a teacher, state employee, or university staff member in North Carolina, you are likely on the State Health Plan. Because this covers over 700,000 people in our state, it deserves its own section.

As of 2025, the SHP has undergone changes, and more are coming in 2026. Here is the current landscape for accessing Fat Liberation care.

The 80/20 Plan vs. The 70/30 Plan

Most state employees choose between these two PPO options. Both have robust Out-of-Network benefits.

The 80/20 Plan (Enhanced PPO):

• OON Deductible: Typically around $3,750 (individual).
• OON Co-insurance: The plan pays 70% of the allowed amount after the deductible.
• Why it matters: If you see a therapist weekly, you will likely hit your deductible by mid-year, and then your sessions become significantly cheaper.

The 70/30 Plan (Base PPO):

• OON Deductible: Higher than the 80/20 plan.
• OON Co-insurance: The plan pays 60% of the allowed amount.

Important Alert: The “Clear Pricing Project” (CPP) is Ending

For the last few years, the SHP offered $0 copays for visiting “Clear Pricing Project” providers. This program is scheduled to end on December 31, 2025.

• What this means for you: If you have been seeing a therapist for free under CPP, prepare for a copay starting January 1, 2026.
• The 2026 Shift: The SHP is moving to a “Preferred Provider” model and a “Behavioral Health Access Program (BHAP).” While this affects in-network copays, it does not remove your ability to use Out-of-Network benefits. Your right to see a private specialist remains intact.

5. The “Nutritional Counseling” Loophole: Free Care?

Here is the best-kept secret in North Carolina healthcare, particularly for those on Blue Cross NC and State Health Plan policies.

Many plans cover Nutritional Counseling (seeing a Registered Dietitian) as a Preventive Service. Under the Affordable Care Act, preventive services must be covered at 100% (no deductible, no copay) if you use an in-network provider.

The Magic Code: Z71.3

Most doctors code nutrition visits under “Obesity” codes (like E66.9). However, Fat Liberation dietitians—like those at Nutritious Thoughts (Asheville) or Stepping Stones Nutrition (Raleigh)—often use weight-neutral codes when appropriate.

The Code: Z71.3 (“Dietary counseling and surveillance”).

• Why it works: This code is often categorized as “Preventive” rather than “Medical.” It frames the visit as counseling to prevent illness through diet, which applies to almost everyone, regardless of weight.
• The Benefit: On many BCBS NC plans (including the State Health Plan), code Z71.3 is covered at 100% for a set number of visits (often up to 30 visits per year or unlimited).

How to verify this: Call your insurance and ask: “Does my plan cover CPT code 97802 and 97803 with diagnosis code Z71.3 as a preventive benefit? Is there a limit on the number of visits?”

Warning: This generally applies to In-Network dietitians. Fortunately, many HAES® dietitians in NC are in-network with BCBS, even if the therapists are not.

6. Tools & Tech: Stop Doing the Paperwork Yourself

In 2025, you do not need to print PDFs and lick stamps. The process of filing for reimbursement has been automated.

Mentaya & Reimbursify

Many Fat Liberation therapists in NC (like Nurtured Psychology or Carolina Trauma Recovery) partner with services like Mentaya or Thrizer.

• How it works: You put your card on file. You pay the full fee. The app automatically files the claim for you instantly.
• The Cost: Usually a small fee (e.g., 5% per claim) or a monthly subscription, but often the therapist absorbs this or it’s worth it for the time saved.
• The Result: You get the reimbursement direct deposited into your bank account weeks faster than if you mailed it in.

Ask your therapist: “Do you use Mentaya, Thrizer, or Reimbursify? If not, can you provide a monthly Superbill?”

7. The “Good Faith Estimate” & No Surprises Act

Federal law protects you from hidden costs. Under the No Surprises Act, any private-pay healthcare provider must give you a Good Faith Estimate (GFE) before you start treatment.

What the GFE tells you:

• The cost per session.
• The estimated duration of treatment.
• The total estimated cost for the year.

Why this empowers you: It removes the mystery. You can take this GFE, look at your budget, calculate your OON reimbursement, and know exactly what your monthly investment will be. If a provider bills you $400 more than this estimate, you have a federal right to dispute it.

8. Step-by-Step: How to Verify Your OON Benefits Today

Don’t guess. Know your numbers. Call the number on the back of your insurance card (Member Services) and use this exact script.

The Script:

1. “I want to check my Out-of-Network benefits for outpatient mental health.”
2. “What is my Out-of-Network Deductible? How much of it has been met this year?”
3. “Once the deductible is met, what is my Co-insurance percentage? (e.g., do you pay 60%, 70%?)”
4. “Is there an ‘Allowed Amount’ cap for CPT Code 90837 (60-minute psychotherapy) in zip code?”
   • Note: They might not tell you the exact dollar amount, but push them for a range.
5. “How do I submit a Superbill? Can I do it online?”

Conclusion: You Are Worth the Investment

It is valid to feel frustrated that insurance makes it this hard to get the care you need. It is a systemic failure, and Fat Liberation therapy is partly about recognizing that these systems are broken.

But do not let the system win by keeping you from care.

By utilizing your Out-of-Network benefits, exploring preventive nutrition coverage, and leveraging technology like Mentaya, you can make radical, life-affirming therapy a reality.

Ready to start?

• Check our Rates page: We explain exactly how we help you file for reimbursement.
• Ask for a Superbill: We provide detailed monthly statements for all private pay clients.
• Know your worth: Investing in healing from diet culture is an investment in the rest of your life.

Disclaimer: This guide is for educational purposes only and does not constitute financial or legal advice. Insurance plans vary widely. Always verify benefits directly with your provider.