Health Insurance Shouldn't Be So Confusing: A Simple Overview Of Out-Of-Network Benefits

So you’ve decided to explore the world of therapy and you’re unsure about where to begin. It’s not always easy figuring out how to access therapy and how to start the process. Deciding to work with a therapist can be intimidating altogether, especially when trying to navigate the complicated world of health insurance. Insurance can be tricky, and you may be wondering if you should work with a therapist that is in or out-of-network with your insurance. One of the most important aspects to your healing journey is finding the right therapist, and by limiting your search to only in-network, you could end up missing the opportunity of finding a therapist who is the best match for you. Most people assume that choosing to stay in-network would be easier and less costly, but as it turns out, that’s not always the case!?

What does it mean to use OON benefits?

Using your out-of-network (OON) benefits means that the therapist is not “in-network” with your insurance company. How it works is that you would pay out of pocket for the cost of your session, and then you can submit the claims to your insurance company for reimbursement. Additionally, reimbursement can look different depending on the type of insurance and plan you have. Some practices will offer to submit the claims on your behalf, to help make this process a bit more seamless. It’s important to know the right questions to ask your insurance so that you can get some clarification on how much reimbursement you will receive. There are some plans that reimburse up to 80-90% of the cost! In some situations, using your out-of-network benefits can end up being more affordable, and it’s definitely worth looking into!

Why are OON benefits better than using in-network benefits?

Using your out-of-network benefits can end up working out better for you than going through insurance. If you find a therapist that you really want to work with, whose set of skills are aligned with your needs, you could end up feeling better quicker ..which means less sessions! Choosing to work with someone solely because they're in-network could end up being a total waste of time and money! If you are looking for a therapist with specific specializations or expertise, then you should consider looking out-of-network. Oftentimes, private pay therapists have a certain niche or focus and you may find that their unique set of skills speaks directly to your needs. Additionally, working with a private pay therapist allows for a more creative treatment plan that can offer you longer or more frequent sessions. When going through your insurance, you are actually limited to the amount of sessions they cover, the durations of these sessions, and the types of services they cover. If you are looking for highly personalized services, I recommend searching for a therapist outside of your insurance network.?

Another reason people consider paying out of pocket, is for privacy reasons. If you are on your parent’s insurance plan and are uncomfortable with them knowing you are going to therapy, you might consider not going through insurance. Privacy from your health insurance company is also a reason some choose to pay out of pocket, since therapists are required to provide the insurance company with information such as a diagnostic code.?

Figuring out insurance is difficult, and we are here to help. We’ve put together a guide of some of the questions, terms, and concepts to help you figure out your out-of-network benefits:

Here’s what you need to ask your insurance company to understand what your plan offers:

• Do I have out-of-network outpatient mental health coverage?
• What is my out-of-network deductible and has any of it been met?
• What percentage of outpatient psychotherapy sessions are covered per session?
• How many outpatient therapy sessions are allowed per calendar year?
• What is the process for submitting claims?
• How often do you provide reimbursement/ When are the superbills due?

Some questions to ask your mental health provider:

• Can you file insurance reimbursement claims on my behalf?
• Do you provide a superbill that I can submit to my insurance company?
• What information do I need to provide to you for billing purposes?

Investing in therapy communicates to your internal world that you matter, that you are valued, and that you deserve to be nurtured. Therapy can help you take a hold over your life, build your self-esteem & self-confidence, and make life feel intentional again. To begin therapy at Repose, click here to schedule a 15-minute free consultation with our client concierge.?