NYU Employee Benefits for Out-of-Network Psychiatric Care

Home > NYU Employee Psychiatrist

NYU employees hold one of the stronger out-of-network mental health benefits I've reviewed, and unlike most private employers, NYU posts the documents where anyone can read them. The number that matters sits in the mental health row of the 2026 Summary of Benefits and Coverage for the Advantage plan: out-of-network outpatient mental health office visits are covered at 30% coinsurance, and the deductible does not apply. The plan pays 70% of its allowed amount beginning with your first visit of the year.

That deductible waiver deserves a sentence of appreciation, because it is rare. The Advantage plan's general out-of-network deductible is $2,600 for an individual, and for most out-of-network services you'd pay that before the plan contributed a dollar. Mental health office visits skip it. For comparison, the Google employee plan I reviewed on the gPPO page applies its $800 deductible before its 70% kicks in. An NYU employee starting weekly psychotherapy with an out-of-network psychiatrist in January is reimbursed from week one.

The plan changed administrators, and the numbers carried over

Aetna replaced UnitedHealthcare as the plan's administrator on January 1, 2026, and the plan was renamed from UHC Choice Plus to Aetna Choice POS II. I read both years' SBCs side by side, and the figures relevant here are identical: $400/$800 in-network and $2,600/$5,200 out-of-network deductibles, $3,000/$6,000 in-network and $8,000/$15,000 out-of-network out-of-pocket maximums, a $30 in-network mental health copay, and the 30% out-of-network mental health coinsurance with the deductible waived. Claims now go to Aetna, member services now answers at Aetna, and anyone still working from a 2025 UnitedHealthcare card should reread their documents.

Both SBCs carry two cautions worth repeating. Out-of-network providers can bill above the plan's allowed amount, and that excess is yours and doesn't count toward the out-of-pocket limit. And certain services require preauthorization, with a $400 penalty for missing it on non-network care; routine outpatient office visits are generally outside that requirement, and confirming for your specific situation takes one question on the member line.

The allowed amount, and what changed with the carrier

Out-of-network reimbursement always turns on the allowed amount, and here the record splits by era. Under UnitedHealthcare, NYU's 2022 Summary Plan Description defined out-of-network eligible expenses at 190% of the rates published by CMS for Medicare for the same or similar service in the geographic market, with a gap methodology when no CMS rate exists. That multiple is meaningfully richer than typical commercial benchmarks; the Empire Plan, the strongest I've reviewed, uses 275%, and I walk through why the multiple matters on the Empire Plan page.

Aetna's 2026 allowed-amount basis for this plan is not in the public documents, and I won't guess at it. The honest move is one call to the Aetna member number on your card: give them the CPT codes the practice bills and the provider's ZIP code (10011 for this office) and ask for the allowed amount for each code. If Aetna carried the UHC-era basis forward, this benefit remains excellent; if the basis changed, you'll know before your first claim rather than after.

What the arithmetic looks like

An illustration using the plan's verified coinsurance and a hypothetical allowed amount. Say your psychiatrist charges $450 for a follow-up visit with psychotherapy and Aetna quotes a $350 allowed amount for that code:

Charged fee:                       $450
Aetna's allowed amount:            $350   (get the real figure from the number on your card)

From the first visit (no deductible on MH office visits):
Plan reimburses:                   $245   (70% of $350)
You pay:                           $205   ($105 coinsurance + $100 above the allowed amount)
Effective coverage:                 54%   of the charged fee

Your 30% coinsurance accumulates toward the $8,000 out-of-network out-of-pocket maximum, after which the plan pays 100% of its allowed amount for the rest of the year. Weekly treatment makes that math friendlier as the year runs; the amounts above the allowed amount stay yours throughout, which is why the allowed-amount phone call is the single highest-value fifteen minutes in this process.

Who this page covers, and who it doesn't

The figures above come from the Advantage plan's SBC. NYU also offers a Value plan on the same Aetna Choice POS II network with different cost sharing, and NYU Langone Health employees have their own plan with its own documents. The plan name is printed on your card and in your benefits portal; match it to the right SBC before relying on any number here, including mine. All the university's SBCs are posted publicly on NYU's HR site, which is to the university's credit and made this page checkable.

What my practice offers NYU employees

I'm an out-of-network psychiatrist, which is the situation this benefit exists for. I see patients in person at Integrative Psych, 80 Eighth Avenue in Chelsea, a fifteen-minute walk up from Washington Square, and by telehealth anywhere in New York State under license #275559. Visits run 30 to 60 minutes, medication and psychotherapy are handled by the same clinician, and a superbill for your Aetna claim follows every appointment; the mechanics are on the superbill page and in Integrative Psych's out-of-network reimbursement guide.

The clinical work spans ADHD evaluation and treatment, depression, anxiety, and psychiatric medication management, in adults, adolescents, and children, including NYU employees' covered dependents. Faculty and staff whose presentation is straightforward have a genuinely good in-network option at a $30 copay, and I'd tell you to use it; the out-of-network benefit earns its keep when diagnostic complexity, medication questions, or continuity with a single clinician matter.

Confirm your own numbers before you book

Five questions for the Aetna member line, adapted from the general benefit-check script:

1. "Am I on the Advantage plan or the Value plan?" (Your card and benefits portal both say.)
2. "Confirm my out-of-network benefit for outpatient mental health office visits: is it 30% coinsurance with no deductible?"
3. "What is the allowed amount for CPT code [ask the practice which codes it bills] in ZIP code 10011?"
4. "Does anything about outpatient mental health visits require preauthorization?"
5. "Where do I submit out-of-network claims, and do I need a claim form beyond the superbill?"

Read the documents yourself

Every figure above comes from documents NYU publishes on its own HR site:

• 2026 Advantage Plan SBC (Aetna Choice POS II, coverage period 01/01/2026–12/31/2026)
• 2026 Value Plan SBC (for comparison, if you chose the Value plan)
• 2025 Advantage Plan SBC (UnitedHealthcare Choice Plus, the prior administrator, same cost sharing)
• 2022 Advantage Plan Summary Plan Description (the UHC-era 190%-of-Medicare allowed-amount definition, Section 3)

Guides for professionals and specific plans

• Empire Plan (NYS employees) — The 275%-of-Medicare benefit for state workers
• Google gPPO — Google employees' out-of-network benefit, from the SBC
• Meta employees — Beyond the 25 Lyra sessions
• 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 NYU insurance cover out-of-network psychiatrists?

The Advantage plan does, on strong terms. Per the 2026 SBC, out-of-network outpatient mental health office visits are covered at 30% coinsurance with the deductible waived, so the plan pays 70% of its allowed amount from your first visit. Your 30% counts toward an $8,000 out-of-network out-of-pocket maximum. The Value plan and the NYU Langone plan have different terms; check the SBC for your own plan.

Does the out-of-network deductible apply to therapy and psychiatry visits on the NYU Advantage plan?

Not to office visits. Both the 2025 and 2026 SBCs state the deductible does not apply to outpatient mental health office visits, in network or out. The general $2,600 out-of-network deductible applies to other out-of-network services. This waiver is unusual among employer plans and is the single best feature of NYU's mental health benefit.

What changed when NYU moved from UnitedHealthcare to Aetna in 2026?

The administrator and the network label changed; the cost sharing carried over. The 2026 Aetna Choice POS II Advantage SBC shows the same deductibles, out-of-pocket maximums, and mental health coinsurance as the 2025 UnitedHealthcare version. One open item: UHC's plan documents set the out-of-network allowed amount at 190% of Medicare rates, and Aetna's 2026 basis isn't published, so confirm the allowed amount for your psychiatrist's billing codes with Aetna before your first claim.

How much will the NYU plan actually reimburse per visit?

Seventy percent of Aetna's allowed amount for the billed CPT code, from the first visit. The allowed amount is the number to pin down: call the Aetna member line with the practice's CPT codes and ZIP code 10011 and ask for the dollar figure for each. Anything your psychiatrist charges above the allowed amount is yours and doesn't count toward the out-of-pocket maximum.

I work at NYU Langone. Does this apply to me?

No. NYU Langone Health employees have a separate plan with its own documents and terms. This page describes the university's Advantage plan. Match the plan name on your card to the corresponding SBC before relying on any figure here.

Is Dr. Sultan in the Aetna network for NYU employees?

No. The practice is out-of-network with all insurance, which is the situation the Advantage plan's out-of-network benefit exists for. In network, your mental health office visits are a $30 copay, and for straightforward needs that's a genuinely good deal. The out-of-network benefit is for choosing a specific psychiatrist and keeping medication and psychotherapy with one clinician.