What is out-of-network insurance coverage

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Are you Struggling to Find a Therapist With Availability? Try using your out-of-network insurance coverage.

While many people limit their search for a therapist to in-network therapists who accept insurance, it can be a struggle. Therapists who take insurance tend to be booked to total capacity and have long appointment waiting lists. Widening your search to include out-of-network, private practitioners can help you expand your therapist pool.

Those looking for help often don’t realize that, depending on their health insurance plan, they may be entitled to reimbursement of a portion of the cost of seeing a private therapist. If you have out-of-network insurance benefits, you’ll get partial reimbursement for out-of-network services, making private therapy more cost-effective and budget-friendly. Typically, out-of-network coverage provides 65 to 70% reimbursement of a private therapist’s fee. You may not even realize that you are covered. Out-of-network coverage is frequently included in your employer-provided medical insurance.

The first step in taking advantage of out-of-network coverage is checking your insurance benefits.

  1. Call the number on the back of your medical insurance card and ask the agent to confirm that you have out-of-network benefits. If you do, ask the following:
  2. “What is my out-of-network reimbursement rate for seeing an out-of-network therapist?” Finally, ask them
  3. “How do I submit claim forms for reimbursement?”

Most private therapists are glad to provide you with a document called a “superbill” that you send directly to your insurance company at the end of each month. The information on a superbill can also be submitted electronically through your insurance website, which speeds up the process. Ask your therapist for this document. The superbill provides information such as how many sessions you’ve had, the total fee, and several important codes. This information is required for insurance reimbursement.
You will receive your out-of-network reimbursement directly from your insurance company, either as a paper check or through direct deposit.
Word to the wise, though, In order to use out-of-network benefits you will usually be required to pay your therapist their entire session fee at the time of service. Following that, after you submit your claim, your insurance company will send you a payment to reimburse a portion of that cost.

I think that more providers should let mental health clients know about the out-of-network benefits reimbursement process to help them navigate the confusing journey of finding psychological support. In my experience, I find that most of my colleagues who are out-of-network providers are happy to advise and guide their clients on submitting superbills if they just ask them.

Don’t give up on getting connected with a mental health professional if you feel you could benefit from it. It is worth it to find out if you have out-of-network coverage by following the steps above. You deserve a therapist who is the perfect fit for you. Don’t stop there. Even if you don’t have out-of-network coverage, still consider talking to a private therapist. They might have a sliding scale fee or offer payment plans to make care more accessible to everyone.