QUESTION # 1:
Have you checked with your insurance company so you know whether or not you have to see a therapist in their insurance network? YES / NO
Many of the clinicians who are best for our particular needs may not be in our insurance network. However, many insurance companies have benefit plans that allow patients to see therapists who aren't in the network.
95% of the patients I see use insurance to pay for therapy.
We are living in a very different world when it comes to health care. For a variety of reasons related to patient confidentiality and constraints on treatment, it is becoming more common for an experienced clinician in private practice to refuse to participate on insurance panels. But this doesn't mean that patients cannot use their insurance to pay for treatment.
The phrase, "pay out of pocket" for therapy, has become synonymous with a therapist not being covered by insurance when most of the time all it means is the patient pays for therapy upfront and the insurance company reimburses later.
When we hear the words, "Sorry, I don't take insurance" many of us make the mistake of assuming that this means that the therapist won't be covered by our insurance plan and that therapy will be cost prohibitive. In actuality, clinicians saying that they do not take insurance are saying that they don't bill insurance companies for their services, not that you can't use your insurance for pay for therapy.
To clarify, if you have out-of-network benefits, you can see whomever you choose to see for therapy and your insurance company will reimburse you according to your plan for what you paid the therapist upfront.
YOU HAVE NOT CHECKED IN WITH YOUR INSURANCE COMPANY YET >
Before you start looking for any therapist or physician online, it is important to check with your insurance company about any limitations to your healthcare plan that may affect the Therapists you can see.
Contact member services and tell them that you are looking for a therapist and need to know about your current behavioral health plan.
Do I have out-of-network benefits? If so, what are they?
Are there any restrictions on who I may see for behavioral health treatment?
Do I have a deductible that has to be met before you will cover services that are out-of-network?
YOU HAVE DISCOVERED THAT YOU DO HAVE OUT-OF-NETWORK BENEFITS >
QUESTION # 2:
Would you like someone else to file your insurance claims and work with your insurance company on your behalf?
Doing the claims paperwork in order to get reimbursed for expenses used to be the biggest deterrent to choosing a therapist who is out-of-network. Many of us with the necessary benefits will still see someone in our insurance's network because we don't want to go through the seemingly arduous process of getting our money back.
If you have a plan with out-of-network benefits, you are already paying for the privilege to see the therapist or doctor who is best for your needs. When all is said and done, a copay is just a copay, regardless of how it gets paid.
Delegate & Be Happy.
Since the number of clinicians who want to contract with insurance companies is shrinking, the field of patient-centered billing services has been growing steadily. See below. Since I resigned from insurance panels many years ago, most patients have been using Lisa Marshall's billing services. Once you sign up with her, you don't have to do anything but open up the envelope with your reimbursement check. Better is a new company that was designed as an app for use on a mobile device.
Lisa Marshall, a medical billing expert for providers for over 20 years, has developed a new service devoted to claims reimbursement for patients. Unlike many billing services, Lisa will contact your provider directly to get information needed for claims. If you are unsure whether or not your plan qualifies for reimbursements or you want more information about her services, you can download a pdf form HERE.
Better is an app for filing out-of-network health insurance claims. You photograph the Superbill provided by your therapist and Better does the work to get your reimbursements. Learn more about Better services HERE
Would you rather submit your own claims forms?
No problem. Speak to your insurance company about how and where to send in your receipt for the reimbursement of your therapy expenses. Upon request, I can provide you with a Superbill receipt for the prior month of services.
QUESTION # 3:
Why should I see someone out-of-network?
Your therapist should be focused on your needs and your goals, not those of your insurance company.
Even if your plan does not cover treatment with an out-of-network clinician, there are very good reasons to work with a clinician who is not beholden to an insurance company.
What happens in therapy stays in therapy.
Maintaining patient confidentiality is the key to a sense of safety in treatment. But in order to secure services for you, clinicians are required to send treatment notes, plans, and diagnostic assessments to the insurance company. Your records go into a permanent database.
Therapy approach and duration is determined by your clinical needs, not your insurance company's bottom line.
When working with insurance companies, the term and nature of patient treatment is assessed and arranged by the insurance company. Therapists speak to insurance reps (who have never met the patient) and send in documentation to try and make a case for the necessity of treatment. In the end it is the insurance company, not your therapist, who will decide whether or not you need therapy and for how long. An insurance company is always going to go for short term treatment, which is great for motivating and organizing but not so good for addressing deeper clinical issues, habits, and change.
Therapists can put you first and stay in business.
A therapist who accommodates or terminates treatment in order to satisfy an insurance company's requirements is not putting the patient first. A therapist who is required to accept a lower fee to do double the work outside of therapy hours can't keep a practice open. When a patient sees a therapist who is not in network there is no negotiation for approach and duration of treatment, no break in patient confidentiality, and the therapist's full focus can be on the patient, not on insurance or business concerns.
In essence, if you have any concerns about your privacy or constraints on your level of care, you may not want to use your insurance for treatment.
QUESTION # 4:
How much does therapy cost?
If you have out-of-network benefits your insurance company will be reimbursing you for the fee you paid your therapist minus your copay or any deductible. The ultimate cost of therapy would vary depending on your particular plan.
Rates for individual therapy and clinical consultation vary according to the type of service and duration. For example, the Initial Office Visit is 75-90 minutes so the fee is $225 rather than $150, for 50 minute individual sessions.
I give discounts for advance payment of multiple sessions and temporary sliding scale fees for patients already in my care for at least six months in certain cases of financial/situational hardship (e.g., recent job loss, single parent family).
Rates for group therapy or trainings are determined by the treatment approach, the materials needed, the facilitator's rate, and the duration of the program. Weekend meditation sessions are typically priced low and there is always the option of paying less or nothing if the cost is prohibitive.
I offer a free phone consultation prior to the Initial Office Visit. During that time you can share your current concerns, discuss treatment options, and get answers to questions about insurance and fees.