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 even if the options are less expansive. There are a couple of ways to learn if you have OON benefits and what they are. The first is to log into whatever online portal you use and search for an out of network tab. The second is to call the number on the back of your card and ask for the details. You will want to ask what deductible you have to meet before reimbursement benefits kick in, and what percentage your company will be reimbursing you. You will also want to ask if the percentage is based on the allowed amount (what insurance sets as the rate for services) or the clinicians amount (what is actually charged). If you get answers to all of this, there is one more thing you’ll want to learn which I’ve outlined in the section below. I have spent a total of days on the phone with insurance companies, so I empathize with the work that goes into this and I am here to support you through it!
How Does Out of Pocket Work?
While in your portal or on the phone with your insurance company, you’ll want to determine what the process is like for submitting reimbursement 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.
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 15 minute consult.