What it means to work with out-of-network providers and how to ask your health insurance provider about out-of-network benefits, out-of-pocket costs, and reimbursement.
"Do you take insurance?"
This is often one of the first questions I hear from potential new clients. And for good reason! It's the start of discussing how services will be paid for. I am an out-of-network provider, which means that I do not accept payment through in-network health insurance benefits. I will provide clients with monthly superbills to submit to their insurance companies for reimbursement, if they have an out-of-network mental health benefit.
For any of you who may be asking yourselves, what are superbills?
"A superbill is a receipt or invoice provided by the practitioner after the client has paid for and received services. The superbill contains all of the information needed by the insurance company to process a claim. This is the document that you would submit to your insurance provider for possible reimbursement."
An important point to make is that reimbursement is only possible if you have an out-of-network mental health benefit and if you have met your deductible. Reimbursement rates typically range between 50%-80% depending on your plan. If you are unsure of whether you have such benefits available to you, the next step is to contact your insurance company directly to ask the Member Services department. If you just cringed or rolled your eyes, it's okay. I'm about to make the call much less painful.
The most effective and efficient way to get the answer you are looking for from your insurance company is to have the questions you need answered mapped out in front of you. Take a look at the back of your health insurance card and find the Member Services phone number.
This is the number you will call to find out about your out-of-network mental health care coverage, out-of-pocket costs, and reimbursement details.
Ask your insurance company representative the following:
Do I have out-of-network outpatient mental health coverage?
What is my out-of-network deductible?
What percentage of outpatient psychotherapy sessions are covered per session?
How many outpatient therapy sessions are allowed per calendar year?
What is the process for submitting claims?
I know my benefits, now what?
The decision of whether to work with an in-network or out-of-network professional is a personal one. The primary benefit of working with an in-network professional is that you will likely only be financially responsible for a copay and your insurance company should be able to provide you with a list of qualified, covered providers. If you want to diversify your search beyond in-network options, then you may choose to explore the realm of out-of-network mental health professionals. There is no right or wrong or better or worse. The truth is, when you find the right therapist, the connection is there whether he or she is in or out-of-network. I can only speak for my practice but I can tell you that I am willing to work with clients to find a fitting or manageable fee that reflects the personal investment in themselves and in their work with me.