Since many insurance plans only cover in-network providers, it can be challenging to find a therapist who accepts your insurance or to afford the cost of therapy without insurance coverage. However, seeing a therapist who is out-of-network can come with several benefits, including greater flexibility, more personalized care, and even cost savings in some cases.
So, if you’re considering starting therapy, you may want to consider seeing an out-of-network therapist.
What is an Out-of-Network Provider?
If you are like me, sometimes all of the different terms that get thrown around when we talk about insurance can be overwhelming. It can almost feel like insurance companies are making it complicated on purpose.
Basically, out-of-network means the provider does not have a contract with your insurance company. If your insurance will cover out-of-network providers, it means that they will reimburse you for the costs of therapy once you give them the proper documentation.
Using your benefits like this can actually come with quite a few perks. It is all about getting the most out of your insurance benefits.
The Benefits of Seeing an Out-of-Network Therapist
Like I talk about in this article, there can be many benefits to seeing an out-of-network clinician. Some of the benefits are that you have more options for who you choose as a therapist, more personalized care, more privacy, and more potential cost savings.
You can choose whichever of these benefits is most important to you. The ones I hear, time and time again, that people appreciate are the increased privacy and the increased choice of providers. It can be so frustrating when the therapist you want to see is not covered by your insurance’s in-network benefits. If you want more information about how this all relates to In-Network benefits, read this article.
Now that we know what out-of-network care means and what the potential benefits are, how exactly does it work? It must be complicated, right?
How to Get Out-of-Network Reimbursement for Therapy
The process can be pretty straightforward if you know the right questions to ask. Let me outline the process for you.
Step 1: Check Your Health Plan Benefits, In-Network vs Out-of-Network Provider
Before starting therapy with an out-of-network healthcare provider, it’s important to check your insurance plan’s benefits. Many plans include out-of-network benefits, which means they will reimburse you for a portion of the cost of seeing an out-of-network provider. However, the amount of reimbursement and the criteria for eligibility can vary widely depending on your plan. Contact your insurance provider to understand your benefits, reimbursement amount, and out-of-network costs.
When you call them, ask “What are my out-of-network benefits?” Another way to handle this is get the therapist’s credentials (license number) whom you want to work with and provide them to your insurance. After providing this information to your insurance company, they will let you know if they will cover these sessions.
This is also a good opportunity to ask them how you will be submitting your claims. Most health insurance companies have portals that you can sign into. If you are good to see them out-of-network, you are good to move on to the next step!
Step 2: Ask Your Therapist About Their Billing Policies
When seeing a therapist, be sure to understand their billing policies upfront. Ask about their session fees. Some therapists may require payment upfront, while others may be willing to submit claims for you. I will explain more about claims later.
All practices are different. In my practice, I have my clients pay upfront, and I provide what is called a superbill. This superbill has things like my credentials, the services rendered, and the amount the client paid. My clients then provide this superbill to their insurance provider, and they get reimbursed.
Depending on the insurance company, this reimbursement process can be quick or take a little bit.
Step 3: Keep Detailed Records of Your Sessions and Payments
I want to make sure you get everything you are owed, so be sure to keep detailed records of your therapy sessions and payments. Save receipts, invoices, and any other documentation related to your mental health care. This will make it easier to submit claims for reimbursement and ensure you receive the correct amount.
It does not matter whether you keep these copies digitally or as paper copies. The more information you have, the smoother this process will be.
Step 4: Submit Claims for Reimbursement From You Health Insurance Company
Like I mentioned earlier, once you’ve completed a therapy session with a provider, you’ll need to “submit a claim” to your insurance provider for reimbursement, or you can provide them with the superbill.
Submitting a claim typically involves filling out a form and providing documentation of your counseling sessions and payments. Be sure to follow your insurance provider’s guidelines for submitting claims to ensure your claim is processed in a timely and accurate manner. Frustratingly, every insurance is different. So do not be afraid to ask them a bunch of questions to make sure you are doing it right.
In this article, I talk about some of the questions that can be helpful to ask.
Remember Your Deductible: Upfront Out-of-Pocket Costs
One final thought, make sure you keep your deductible in mind! Depending on the health insurance plan you have, you may have incredibly high deductibles. This means that insurance would not cover ANY service (does not matter in-network or out-of-network) until that deductible is met.
So, just because your health plan will cover out network services, you still may be responsible for paying a large amount until your health insurance plan has had its deductible met. If you are not really close to meeting your deductible, you may want to consider just paying out-of-pocket for a self-pay therapist.
Final Thoughts
Seeing an out-of-network counselor can come with several benefits, like greater flexibility, more personalized care, and even potential cost savings. Figuring out how to navigate the process of getting reimbursed for therapy may seem daunting, but following these steps can help you get the care you deserve and make therapy more accessible and affordable for you.
Remember, seeking mental health treatment is an act of self-care and self-compassion. Whether you choose to see an in-network or out-of-network clinician, what’s most important is finding a provider who can support you on your journey to better mental health. Don’t be afraid to advocate for yourself and take the necessary steps to get the care you deserve.
Until next time,
