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?

Click on one of the options below:

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 who do not take insurance are saying that they don't bill or barter with insurance companies for their services, not that you can't use your insurance to pay for therapy.

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 behavioral health plan.

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?

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. With an out-of-network provider, you will be reimbursed by insurance for what you paid for treatment, minus your copay.

Delegate & Be Happy.

Reimbursify is a company that has developed an app for your phone that will handle all of your out-of-network health insurance claims simply and easily.

From their website: “You see your out-of-network healthcare provider and pay for the visit. They will give you a detailed receipt (known as a “superbill”) that has the necessary information on it to file a claim with the Reimbursify app within minutes. The app will alert you when the claim has been received by your insurance company and then again when you should expect your reimbursement check in the mail (usually within 2-4 weeks). That’s it! There are no forms to fill out, nothing to fax or mail, and nothing to remember.” Learn more by visiting REIMBURSIFY and get your first several claims for free!

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. The Superbills are automatically generated monthly for patients and available through the client portal.

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. For example:

• 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 don’t know the patient) and are required to send in documentation to 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 motivation and problem-solving but not so good for addressing deeper clinical issues and lasting change.

• Therapists can put you first and stay in business.   

A therapist who adjusts 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. 

However, 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 policies 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 depend 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 $250 rather than $175, for 50 minute individual sessions.

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.