gPPO Out-of-Network Benefits for Psychiatric Care

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Google employees carry two mental health benefits at once, and in my experience most use one and forget the other exists. The first is Lyra: 25 free coaching or therapy sessions per person per year, and it's a genuinely strong program. The second is quieter: the PPO plan itself covers out-of-network psychiatry at 70% after a modest deductible, which means you can see any psychiatrist in Manhattan, not just whoever has an opening in a directory.

Every figure on this page comes from the 2026 Summary of Benefits and Coverage for "Google, Inc.: PPO," the document Anthem files for your plan, hosted on Google's own benefits portal. It's linked at the bottom, along with the Lyra overview flyer from the same portal, so you can read both yourself. I'm a psychiatrist, not a billing advocate, and where the documents don't publish a number, I say so rather than guess.

Who has this benefit

This page describes the Anthem PPO option in Google's US benefits, the plan employees shorthand as the gPPO. If you picked the gHIP, the high-deductible option, your deductibles and cost sharing are different; if you picked Kaiser, you're in an HMO without comparable out-of-network coverage. The plan year matters too: the numbers here are from the SBC for coverage period January 1 through December 31, 2026. Check your own plan's SBC before relying on anything here.

What the SBC actually says

The mental health row of the 2026 SBC ("If you need mental health, behavioral health, or substance abuse services") reads as follows for outpatient care:

• In-network office visits: a $20 copayment per visit, and the deductible does not apply. If a network psychiatrist fits your needs and has availability, that is the cheaper path, full stop.
• Out-of-network office visits: 30% coinsurance, meaning the plan pays 70% of its allowed amount after your out-of-network deductible. Other outpatient services are the same 30%.
• Limits: the limitations column for outpatient mental health reads "none."
• Referrals: none needed. The SBC states you can see the specialist you choose without a referral.

The framing numbers around that row:

• Deductible: $800 per individual, $1,600 per family, for out-of-network providers ($400/$800 in-network). By Manhattan standards that is a small deductible; weekly treatment meets it inside the first month or two.
• Out-of-pocket limit: $5,000 per individual, $10,000 per family, for out-of-network providers. Your 30% coinsurance accumulates toward it, and once you cross it the plan pays 100% of its allowed amount for the rest of the year.
• What doesn't count toward the limit: the SBC is explicit that premiums, balance-billing charges, and provider charges above Anthem's "maximum reimbursable charge" are excluded. That last phrase is the one to understand before you book.

The allowed amount is the number the SBC doesn't print

Here is the honest limitation of this page. The SBC tells you the plan pays 70%, but 70% of what is set by Anthem's maximum reimbursable charge for each service code, and that figure isn't published in the document. Commercial insurers commonly set allowed amounts below Manhattan private-practice fees, which is how "70% coverage" can turn into a smaller check than you expected; I walk through that arithmetic on the out-of-network cost page.

The fix is one phone call before your first visit. Call the member number on your Anthem card, give them the CPT codes the practice bills and the provider's ZIP code (10011 for this office), and ask: "What is the maximum reimbursable charge for each of these codes?" Anthem will quote you actual dollar figures, and at that point the arithmetic below stops being hypothetical.

What the arithmetic looks like

An illustration with the plan's verified percentages and a hypothetical allowed amount. Say your psychiatrist charges $450 for a follow-up visit with psychotherapy, and Anthem quotes a $300 maximum reimbursable charge for that code. (The $300 is illustrative; get the real figure from Anthem first.)

Charged fee:                       $450
Anthem's allowed amount:           $300   (get the real figure from the number on your card)

After the $800 deductible is met:
Plan reimburses:                   $210   (70% of $300)
You pay:                           $240   ($90 coinsurance + $150 above the allowed amount)
Effective coverage:                 47%   of the charged fee

If Anthem's quote comes back at $400 instead, the plan pays $280 and your effective coverage is 62%. The spread between those outcomes is exactly why the phone call matters. Two features improve the picture over a full year: the $800 deductible is met once, and every coinsurance dollar counts toward the $5,000 limit, after which the plan pays 100% of its allowed amount. The worst months are the first ones.

Use Lyra. Also know when you've outgrown it.

The 25 free Lyra sessions are the best first move for a lot of situations: a rough quarter, a breakup, burnout that hasn't tipped into something diagnosable, skills coaching. Free, fast to access, and the quality is real. Google's own Lyra flyer also notes that employees on the Anthem plan have access to care beyond the 25 sessions through the health plan when additional care is needed.

Where the handoff happens is when the question changes from "I want someone to talk to" to "something is wrong and I want a diagnosis and a treatment plan." ADHD that's survived three productivity systems, depression that hasn't moved in months, anxiety that medication might actually fix: that's a psychiatric evaluation, and if medication enters the picture you want prescribing and psychotherapy handled by one physician over time rather than split across a coaching app and a 10-minute med check. That's the service the PPO's out-of-network benefit pays for.

The paperwork is a superbill

Out-of-network practices, mine included, don't bill Anthem. You pay at the time of the visit and receive a superbill, an itemized receipt carrying the CPT service codes, diagnosis codes, and the provider's NPI that a claim requires. You submit it through the Anthem member portal or by mail, and reimbursement comes to you once the deductible is met. The full mechanics are on the superbill page. My practice issues one after every visit.

Confirm your own numbers before you book

Plan terms change by year and I don't work for Anthem, so treat this page as a map rather than a quote. The general benefit-check script applies here; for the gPPO specifically, call the member number on your Anthem card and ask:

1. "Am I on the PPO plan or the gHIP?" (Your benefits portal shows this too.)
2. "What is the maximum reimbursable charge for CPT code [ask the practice which codes it bills] in ZIP code 10011?"
3. "How much of my out-of-network deductible have I met this year?"
4. "Does anything require preauthorization for outpatient office visits with an out-of-network psychiatrist?"
5. "Where do I submit out-of-network claims, and do I need a claim form beyond the superbill?"

What my practice offers Google employees

I'm an out-of-network psychiatrist, which is precisely the situation this benefit was written for. I see patients in person at Integrative Psych, 80 Eighth Avenue in Chelsea, one block from the 111 Eighth Avenue building, and by telehealth anywhere in New York State under license #275559. Visits are 30 to 60 minutes, medication and psychotherapy are handled by the same clinician, and a superbill follows every appointment.

The clinical work spans ADHD evaluation and treatment, depression, anxiety, and psychiatric medication management, in adults, adolescents, and children. Whether an out-of-network psychiatrist is worth it depends on what you're bringing. For a straightforward presentation, a network psychiatrist at a $20 copay, or Lyra at zero dollars, is a genuinely good deal, and I'd tell you to use it.

Read the documents yourself

Every number above comes from documents hosted on Google's benefits portal:

• 2026 Anthem PPO Summary of Benefits and Coverage ("Google, Inc.: PPO," coverage period 01/01/2026–12/31/2026)
• 2026 Anthem gHIP Summary of Benefits and Coverage (for comparison, if you chose the high-deductible plan)
• Lyra at Google overview flyer (25 sessions per person per year; care navigators at 844-801-3175)

Guides for professionals and specific plans

• Empire Plan (NYS employees) — The 275%-of-Medicare benefit for state workers
• Meta employees — Beyond the 25 Lyra sessions
• NYU employees — The Advantage plan: 70% with no deductible on mental health visits
• Lawyers & Big Law — The numbers on attorney mental health, and treatment that fits
• Physicians & residents — What New York licensure actually asks
• Finance professionals — The hours, the U4, and treatment before the market opens
• PPO plan directory — Decode the plan name on your card

Frequently Asked Questions

Does the Google PPO (gPPO) cover out-of-network psychiatrists?

Yes. Per the 2026 Summary of Benefits and Coverage for Google, Inc.: PPO, out-of-network mental health office visits are covered at 30% coinsurance after the $800 individual out-of-network deductible, meaning the plan pays 70% of Anthem's maximum reimbursable charge. The SBC lists no visit limits for outpatient mental health, and no referral is required.

What is the gPPO out-of-network deductible and out-of-pocket limit?

For out-of-network providers, the 2026 SBC lists an $800 individual / $1,600 family deductible and a $5,000 individual / $10,000 family out-of-pocket limit. Your 30% coinsurance counts toward that limit; once you reach it, the plan pays 100% of its allowed amount for covered services the rest of the year. Provider charges above Anthem's maximum reimbursable charge, premiums, and balance-billing charges do not count toward the limit.

How much will Anthem actually reimburse for an out-of-network psychiatrist?

That depends on Anthem's maximum reimbursable charge for each CPT service code, which the SBC does not publish. Call the Anthem member number on your card, give them the CPT codes the practice bills and the provider's ZIP code, and ask for the allowed amount for each code. The plan pays 70% of that figure after your deductible; anything the psychiatrist charges above it is yours.

I get 25 free Lyra sessions. Why would I see an out-of-network psychiatrist?

Use the Lyra sessions; 25 free coaching or therapy sessions per person per year is a genuinely strong benefit. A psychiatric evaluation with medication management is a different service: diagnosis, prescribing, and psychotherapy handled by one physician over time. Google's own Lyra materials note that employees on the Anthem plan have access to care beyond the 25 sessions through the health plan when additional care is needed. Many people sensibly use both.

I chose gHIP or Kaiser instead of the PPO. Does this apply to me?

No. The gHIP is a high-deductible plan with different deductibles and cost sharing, and Kaiser is an HMO without comparable out-of-network benefits. Check the Summary of Benefits and Coverage for your own plan on the benefits portal before relying on any figure here.

Is Dr. Sultan in the Anthem network?

No. The practice is out-of-network with all insurance, which is the situation the PPO's out-of-network benefit exists for. If you would rather stay in network, mental health office visits are a $20 copayment and Anthem's directory or a Lyra care navigator can locate a network psychiatrist.