Seeing An Out-Of-Network Therapist

What on earth is an out-of-network therapist?  Good question.  Insurance plans usually have two categories of healthcare providers that they’ll pay for; one is “in-network” and the other is “out-of-network”.  Your regular doctor is probably in-network.  When you go see your doctor you might pay a small copay and then the doctor’s office and the insurance company deal with the rest of the bill.  If you see a healthcare provider who is out-of-network then you typically pay the full fee upfront and then submit paperwork to the insurance company so they can reimburse you part of the money you paid.

Sometimes I’m able to have the insurance company pay me directly, even though I’m out-of-network.  This saves you money and hassle.  If you call your insurance company and get the details of your coverage then I can figure out if that’s an option in your case.

Talking to Your Insurance Company About Out-of-Network Benefits for Therapy

If you’re thinking about using your out-of-network benefits to cover therapy then you might want to review your insurance policy or give your insurance provider a call and get the answers to the following questions:

• What percentage of the fee do they cover?
• Is that percentage based on what you actually pay or is it based on a rate they’ve set?
• Do you have to meet a deductible before they start paying?  If so, what is it?
• How many sessions will they cover?
• What paperwork do you need to submit for reimbursement?

This is probably enough information for you to get a good sense of how to use these benefits to pay for therapy.

Advantages of Seeing an Out-of-Network Therapist

Despite the some of the drawbacks of seeing someone out-of-network, there are some major benefits.  The biggest one is that your therapist is working for you and only you.  When a therapist is in-network with an insurance company that therapist has to convince the company that you have a mental illness and require treatment.  The therapist may have to have your goals approved by the insurance company in order to continue to see you.  And the insurance company has a right to your records.  When a therapist is out-of-network you have more control over what happens in therapy and it’s up to you and your therapist to set your goals, frequency of appointments, and length of time in therapy.