How To Navigate Your Out Of Network Insurance Benefits
You’ve found a psychologist that seems to be perfect for you. Maybe you’ve heard about them through a coworker or a friend - or maybe you’ve done some light internet stalking and feel like they fit the bill for what you need. But then. . . they don’t take your insurance!
Don’t worry, all is not lost! Many psychologists and counselors are opting to run self pay practices or go In-Network with only a select few insurance companies. There IS a way to be treated by someone who is not In-Network with your insurance company. You can use your Out of Network Benefits, it just takes a little bit of footwork on your end.
I have opted not to participate in insurance panels. Personally, I’ve been dealing with insurance companies since 2004 (having worked in inpatient psychiatric hospitals and residential treatment centers). Most people don’t know that insurance will dictate how much treatment you can have. These case managers have never sat in a room with you - and they are calling the shots. (I remember hearing someone once ask a therapist, “What’s your theoretical orientation?” His response? “Whatever Blue Cross wants it to be”). Once you start making progress, you are often cut off. Do you want to stop treatment once you start getting traction and feeling better? I want us to decide together that treatment is done. Not some person in an office who does not know you. Working on an Out Of Network basis allows me to provide my clients with the best care.
These Psychologists Can Provide Better Therapy
Have you ever wondered what it’s like being a psychologist? My dad was a Clinical Psychologist and I used to joke that he would sleep through his client’s sessions. Wow, was I wrong!
During session, I am fully present with you. Your pain, your triumphs, your setbacks, your tragedies - I’m there through all of it with you. At the same time, I’m treatment planning in my mind to make sure I am providing you with the best therapy available. I’m sorting through all of the education, training and experience I have to ensure that the time we invest together is effective and efficient.
After session, I’m writing detailed notes about my interventions, our progress and what the best next steps are for the next time we see each other. In between sessions I’m thinking about you. I’m keeping myself up to date on the newest research so I can provide you with treatment that is evidence based.
I’m also focusing on my own self care. If I’m overburdened, stressed, or not managing my personal life, it can carry over into our sessions.
Have you ever met with a counselor and felt like they weren’t quite there? Or they started sharing their problems with you? They were a little irritable? Or they said or did something that didn’t feel quite professional? This can happen when a counselor is not living a balanced life, or simply not appropriately trained in psychotherapy. This also means that you are not getting the quality treatment you deserve.
I’m going to be very direct (sidebar: I once had a client say to me, “You are sooooo nice. But also very direct. I don’t know how you do it. It’s a gift”). Psychologists who are on insurance panels must have a high case load in order to cover their business and personal expenses.
YOU WANT A TRAUMA THERAPIST THAT IS 100% PRESENT WITH YOU
This means that you DO NOT want to be client number 6, 7 or 8 for the day because you will have had a Psychologist who has been taking on intense emotions for the past 5 hours. They maybe had lunch (if they’re lucky) and probably won’t remember the details of their earlier sessions to accurately document and treatment plan for the next session. And if they’re not fully present with you? They’re stressed, burned out, hungry and really have to pee. You are sharing your shame, pain and secrets with your psychologist. Do you want to spend your time with someone who can’t wait to get you out the door because they are just doing through the motions of the day? Checking off a box? You don’t want to be a number. Not with this. Not with psychotherapy (especially trauma therapy).
Step 1: Do I Have Out Of Network Insurance Benefits?
I have found that providing care on an Out Of Network basis allows me to spend my energy on you, and make the best clinical decisions. So how do you get reimbursed by your insurance company for using your Out Of Network Benefits?
First off, not all plans have Out of Network Benefits. Take a look at your insurance card. If you have an HMO or EMO plan, you most likely will not have Out Of Network Benefits. Unfortunately, you will need to either find a psychologist who is In-Network with your insurance or self pay. A lot of people who feel strongly about their treatment provider opt to self pay. In fact, many people might begin treatment with a counselor to find that their insurance has decided they don’t want to continue covering sessions - and then people often begin paying out of pocket anyway.
Don’t forget - if you have a Flexible Spending Account (FSA) you can also use that to pay for your mental health treatment - people leave hundreds of dollars of the FSA monies unused. Don’t let that be you!
If you have a PPO or POS type plan, then your next step is to call the customer service number on the back of your insurance card and ask if your specific insurance plan has Out of Network Benefits. If yes, amazing! If you want to have an idea of how much you can expect to be reimbursed, you can follow the steps below. Some people just roll the dice and get pleasantly surprised when they get their reimbursement check. It’s completely up to you!
Step 2: Do I Have An Out Of Network Deductible?
An Out of Network Deductible is the cost you must pay for your out of network benefits before your insurance company will begin paying you back a portion of the monies. You also will want to find out the amount of the deductible and how much you have already met. Not all insurances have an Out of Network Deductible.
Step 3: Do I Have a Co-Insurance?
Co-Insurance is the percentage of the cost you will pay after you have met your Out of Network Deductible (if you have one). For example, if your office visit costs $100 and you have a co-insurance of 10%, then you will FIRST have to have met your Out of Network Deductible and THEN you will be responsible for $10 (as your co-insurance is 10%). After this, your insurance company will cover the remainder of the cost.
Step 4: Is There an Allowed Amount For Mental Health Services?
The allowed amount is the maximum your insurance company will cover for a service. For example, if your insurance company has an allowed amount of $100 per session, and your provider charges more than this, you will not be reimbursed the balance by your insurance company.
Armed With Info
Now that you are armed with this information, you’ll have an idea of what your costs for treatment might be. Or you can wing it (you daredevil). Overall, if you have an Out of Network Benefit, you’ll need to know how much you need to pay before insurance starts helping out (Out of Network Deductible), and if there is a percentage you must pay afterward (co-insurance). Lastly, you’ll know the max your insurance will cover for a service (allowed amount).
Begin Your Treatment With Your Out Of Network Provider
Ultimately, you’ll be able to begin treatment with your preferred provider! You will pay your treatment provider their full fee directly and then submit a Superbill (provided by your counselor) to your insurance company. Your insurance company will do the fancy math and then reimburse you the appropriate portion based on your insurance plan. Some people find that the service Reimbursify can really simplify the process.
Many people find that while initially it can be a little extra work, what is most important is finding the right therapist for you. The healing that comes from investing in treatment with a skilled and gifted counselor that understands you and your needs is priceless!
When you are ready to invest in your healing, click here for a free 15 minute video consultation for Online EMDR.
Online EMDR Therapy and Trauma Counseling in California and Carlsbad, CA.
