Out of Network Participation
Understanding the complex ins and outs of health insurance in the United States is confusing and frustrating. I have spent most of my career feeling this way, and am transparent about how this has influenced my business decisions. I can only speak for myself, but I hope to provide clarity for anyone needing answers on why therapists might be out of network providers. I recognize that the second someone seeking a therapist sees “Out of Network”, they immediately rule it out. This could be due to finances, but also to not knowing their benefits or not wanting to do the paperwork themselves. Life is full and I respect any reasons for seeing “Out of Network” and running for the hills. My intention in this section is to try easing unknowns and expanding your options.
Why Not Take Insurance?
After nearly five years of managing insurance in my career, I have ended my participation with insurance companies. While growing my practice, I have noticed how the more time I spend on various insurance tasks, the less time I have to support clients as a therapist. Insurance companies have extensive paperwork, determine rates, have slower reimbursement times, and sometimes deny claims. These limitations (to name a few) block me from long-term business and personal goals. More importantly, these limits drain the energy I need to put towards clients and preparing for sessions. Stopping in network participation and switching to being an out of network provider puts more responsibility on the client, which is why I offer more information below to make things seem simpler.
What are Out of Network Benefits?
Unfortunately Out of Network (OON) benefits are not always offered by plans. If they are, these benefits can be used through providers who are not contracted with your plan. I am considered an OON provider for all plans. OON benefits can still make a difference, but they tend to offer less options for you as a client. I use a program called Reimbursify which allows easy research around OON benefits and what those benefits are. You will not have to deal with the hassle of calling your insurance company to obtain what you need. Please click the “Use Your Insurance” button if you are interested in learning about your benefits. I will receive your inquiry and will get back to you with the information as soon as possible. It is also something I can quickly look up with some information on a consult call if you choose to schedule one.
How Does Out of Pocket Work?
Reimbursify offers easy submission of your own claims. I charge you directly and after every session I provide you with a document called a Superbill which you will submit for reimbursement. It will show diagnosis and the code for a 60-minute psychotherapy session at the charged rate, and your insurance determines it from there. Reimbursify makes it much easier for you to submit compared to whatever process or forms your insurance company requires. If you have those OON benefits, your reimbursement will be sent directly to you. Explore https://reimbursify.com/ or download the App to learn more.
If you do not have OON benefits and would like to discuss a sliding scale (discounted rate), I am open to this! Please go to the “Contact” tab to reach out and schedule a free 10 minute consult.