Choosing A Therapist Outside Your Insurance Plan

Looking for an out-of-network therapist? Many seek in-network providers to ensure services are covered, but there are reasons why you may want to consider seeking care outside your health plan network of providers using out of network benefits. This article explores options available to you — providing helpful information about navigating health insurance plans for seeking therapy with out of network therapists.

Out-Of-Network Therapist Information

If your current health care provider changes their list of accepted plans, or your insurance was changed to a different company and you no longer have access to work with the therapist you saw before, your next option is to work with an out-of-network therapist or consider private pay therapists and simply pay for the service with cash. Some dread this scenario because it can involve paying out of pocket or submitting complicated insurance claims. But in many cases, out of network therapists can provide the support you need when you can’t find an in network therapist to match your needs. Plus, there could be hidden benefits you might receive by using an out of network benefits and providers such as seeing someone who specializes in your condition. Here are a few things to keep in mind when considering therapist options outside of your network in your current insurance plan.

What It Means When A Therapist Is Out-Of-Network — Does Insurance Cover Therapy?

When a therapist is out-of-network, they do not have a contract rate with your health insurance provider, so they might not accept insurance payments from your plan. An in-network therapist has negotiated what they will earn through your insurance network. It costs patients more to use services out-of-network but costs insurance companies less when you use their in-network professionals. A doctor or specialist may choose to be an out-of-network provider because they did not approve a contract arrangement with the insurance company. Or, they experience a lack of reimbursement for services because the provider may pay less than the full cost when they submit claims.

You may be required to submit a claim to your insurance for out-of-network benefits if your insurance falls under this category. You may also qualify to pay for session fees using cash, but with discount rates, if they apply. Paying the full amount in cash isn't required, but this is an option if you choose to receive services without filing an insurance claim. Some out of network providers may provide a special rate or bundle offers to make it easier to pay when therapy session fees are out-of-network.

Check Your Policy For Out-Of-Network Benefits

Do you have a comprehensive understanding about out of network benefits for your insurance plan? Do you know if your health insurance company has this as part of your policy options? The information about these out of network benefits is part of the summary details for others on your health insurance policy. Your insurance company website may have details about how they handle payments to out of network providers and whether they offer it. If in doubt, contact the insurance company directly and ask about the network offered to you, how many sessions they cover, and what their policy is for out of network reimbursement. Understanding how your insurance plan pays for out of network services is important for other medical expenses as well as payments to receive mental health services. You'll want to know if there are any important details about coverage for mental health services and be sure you have a more comprehensive understanding of these options. Here are some other suggestions you may want to ask your insurance company related to out-of-network therapy:

• Is the out-of-network deductible the same amount as the in-network deductible for mental health specialists?
• Has the deductible been met yet and is there an out of pocket limit?
• What is the coinsurance for outpatient mental health services?
• Do you qualify for reimbursement for out-of-network fees? How are requests for reimbursement made?
• Is a referral required to see an out-of-network specialist?

Some companies will mail you a check reimbursing you for services, but you pay for services with a out of network therapist at the time you meet with them.

Why People Choose To Pay Out-Of-Pocket

Some insurance pays for specific services and sessions, or they cover a certain number within a calendar year. Some people may decide not to work with an insurance company because they are working with a mental health specialist. Usually, a diagnosis is necessary to give a referral, and the insurance company needs that authorization to issue payment reimbursement. Privacy is another concern. The information reviewed at each session stays private, and in most cases, so does billing and financial records. Plus, you may be required to pay out-of-pocket anyway if you need to meet a deductible before the insurance coverage kicks in.

Learn About Potential Costs And Payment Terms

It is essential to check your health insurance policy to learn what is covered and what is not when considering out-of-network coverage. If your doctor refers you to a specialist for therapy sessions, you should check to see if they are in-network or out-of-network. Avoid assuming that they are automatically in-network because this could result in a session fee you weren’t expecting. Research to learn how much you'll pay for services, depending on the network status. Sometimes the cost is estimated before services, and you may learn from checking your policy what you'll be responsible for paying. An added deductible may be included, regardless of the network.

Check payment terms of the therapist you'll be working with beforehand to learn if you need to pay in full, finance, or make flexible payments. Something else to consider is whether the therapist files a claim with your insurance as an out-of-network provider for you. Most therapists do so, but it’s a good idea to ask them. If not, you may need to fill out a form and file the claim yourself, based on their network status and your insurance benefits.

How To Compare Therapists

Choosing the right therapist for you depends on a few factors. Deciding on who is best depends on your personal needs. There are therapists skilled and trained to provide support for different areas of mental health. Some provide short-term therapy and other conduct frequent sessions over a longer time. Some diagnose conditions while others offer various treatment options and combine medication management as part of their highly personalized services. Here are a few things to keep in mind as you compare mental health specialists:

• Review their educational background, credentials, licensing, and training.
• Learn what they specialize in (depression, substance abuse, etc.) and their approaches to treatment.
• Know the type of therapist you want to see (psychiatrist, licensed counselor, psychotherapist, etc.).
• Think about personal concerns you're dealing with and look for a therapist that specializes in that area such as a family therapist for marital issues, or a psychologist for eating disorders.
• Consider if counseling, medication, or both are needed or if you are already receiving either option. If medication is something you're considering for symptoms, you'll need to work with someone who is licensed to prescribe them who also understands medication management. You may need a second specialist who specializes in counseling and talk therapy to assist you in your healing process.
• Review your health insurance policy plan, co-pay and coinsurance rate, and policies regarding mental health services and individual therapy when you switch jobs or your company joins a new insurance network. While you may get a list of in-network therapists to check, it’s a good idea to learn about their out-of-network process ahead of time.

It is recommended to connect with more than one therapist before making a decision. Get leads to potential therapists to compare by getting a referral from your doctor, a recommendation from family or friends, a local mental health organization association, or online therapist directories via local professional search.

Questions To Ask Potential Providers

Gain confidence in your therapist and find out if they are a good fit by asking questions about the important aspects of their care. A wide range of therapists are available, providing services and in-depth support to people every day. People are encouraged to ask questions to learn more about the therapy process and promote a good relationship between you and the therapist you choose. Help yourself get more comfortable with the concept of working with a therapist by making a list of questions to help you break the ice for both you and the therapist. Here are some important questions to consider asking:

• What experience do you have treating clients with depression, anxiety, and related disorders?
• Do you provide treatment for children, adults, or both?
• Does the therapist provide a free first session to new clients?
• What are my options if I don't feel better within a specified timeframe?
• Can you describe your approach and treatment options?
• How can you help me cope with my problem?
• If your insurance covers dependents, what services does the parent’s insurance plan provide?
• Is there a co pay at the time of service?

Using Online Sources For Encouragement & Guidance

Many seeking leads for professional help locally may start their search online. Using online directories for ideas on where to obtain online therapy, mental health advice, or places where you can open up about your views and opinions such as online support groups and forums, may provide additional insight on where to find a therapist that’s right for you. Online forums and social media groups are useful places to learn about personal experiences working with out-of-network specialists and the process after services. You may get a recommendation or learn from others that share the same health insurance provider what to expect. Get more ideas on what questions to ask and learn what others did to ensure they had a good session with their professional.

Choosing to talk with a therapist about your situation is a big step in helping yourself feel better. It is common to be nervous about sharing your feelings with someone new. Taking time to prepare yourself in advance may make it easier for you to make informed decisions about who to talk to so you can see progress as quickly as possible. Researching to learn about therapists ensures you find a compatible option to build a working relationship toward healing and recovery. Some choose not to work with an out-of-network provider because they think they can't afford additional costs. While cost may be a factor in choosing, you may be surprised at how specialists are willing to work out financial arrangements so you can get the help you need.

Your situation will help you determine the best option. You may be responsible for added costs, but sometimes it is advised to work with an out-of-network provider. Situations such as moving, traveling, or seeking specialized care are common reasons for finding an out-of-network provider. Review the listing directory provided by your insurance company to see if the provider is in-network. If they don't appear on the list, they are out-of-network. Talk with your insurance provider to learn the billing process. While some policies cover out-of-network services, you could end up paying the balance. It helps to know this before choosing a provider, so you know what to expect after receiving services.

If you are struggling to pay for therapy, online therapy might be your most affordable option. The reasonable costs might surprise you. Online therapy platforms are known to provide the most affordable out-of-network treatment options. Despite this, scientists also widely believe they deliver the same results as in-person therapy.

If you are living with mental health challenges and your insurance provider does not cover therapists in your area or your network, an online therapist could be right for you. The licensed therapists at BetterHelp are available whenever convenient to diagnose your issues and administer treatment.

Questions People Often Ask About This Topic

Why do therapists choose to be out of network?

Many therapists do not accept health insurance because they say that reimbursement rates are too low, so the amount of money an insurance company pays is not enough to cover for utilities (renting an office space, electricity, etc.). Plus, the vast majority of health insurance companies do not consider many of the reasons why people choose to see a therapist – relationship, couples, or marriage issues, developmental trauma, life transitions, self-development, and other issues not related to a psychiatric diagnosis to be a “medical necessity.” If you want to know if your health insurance will pay for therapy, what are your co-pays, or wish to find an in-network provider, call the number in the back of your insurance card.

How much does a therapist cost?

The out-of-pocket cost of therapy varies depending on your geographical location, your in and out of network benefits (if any), the therapist’s experience, and other factors. A typical individual therapy session at a therapist’s office can cost anywhere from $65 to $300 per hour, although some therapists offer a sliding-scale therapy modality, which refers to a pricing structure that varies up to a certain amount depending on your income.