Out of Network Benefits Explained

You’ve been looking for a therapist who takes your insurance and you keep hitting roadblocks.  I get it. I’ve been there myself. Finding someone who feels like a good fit AND is covered can feel impossible, especially if you’re in an area where there aren’t many therapists who take insurance in the first place.  The out of pocket cost of therapy feels out of reach for you, and you can’t find anyone who has availability with sliding scale/reduced fee who feels like a good fit either. What’s a person to do in such a situation? Give up on going to therapy?  NOPE. Check out your Out of Network benefits!

First, let me explain what Out of Network benefits are. Insurance companies contract with providers who are designated as “in network.” These providers agree to a set fee and oversight by the insurance company. Many therapists don’t accept insurance (especially where I live), but that doesn’t mean you can’t get help from your insurance with your fees. Many plans will reimburse you for some of the fees you pay to see a therapist who is not contracted with them. I will also say that not all plans have Out of Network benefits.  A quick way to determine if yours does is to look at your Summary of Benefits if you have it.  Most plans send one out a month or so before the renewal period. It will probably be labeled something like “Behavioral Health” and reference outpatient services. Another option is to call the Customer Service line listed on the back of your card.  When you do, ask them if you have Out of Network benefits for outpatient behavioral health. If so, be sure to ask if you have a deductible and what the copay/coinsurance is.  Ask as many questions as you need to in order to be sure you fully understand what the coverage is. You will also need to make sure your therapist will provide a Superbill for the services you receive.  Most will, but it’s important to ask to be sure.

It’s also a good idea to ask Customer Service how you go about filing claims for Out of Network services.  Many providers have an easy online portal. For example, mine takes about ten minutes to enter all the information the first time.  After that, it takes less than 3 minutes to enter a month’s worth of claims. The first time, it took close to a month to have services approved and a check mailed to me, but after that, I usually receive reimbursement in less than two weeks.

If your insurance makes Out of Network reimbursement more difficult than that, it might be worth looking into a service like Reimbursify.  I registered my practice with them, which gives my clients their first five claims for free.  After that, they pay 1.99/claim or can buy packages of 10 at a discounted rate. It’s not free like filing directly with your insurance would be, so it’s not necessarily worth it for everyone, but they do help you figure out denials and make it a lot easier than some insurance companies do.  It operates out of an app, and once you’ve got it set up, it’s really quick to use. It’ll also let you quickly track your claim and see the status of your reimbursement. Particularly for plans that make accessing out of network reimbursement difficult, this sort of service can be really helpful.