Use your insurance benefits to get reimbursed.
I am an out-of-network (OON) provider.
What does it mean to be an OON provider?
Great question. It means that I do not have contracts with insurance companies and therefore do not bill them directly. Instead, you pay for your sessions at the time of service. Depending on your insurance plan and out-of-network benefits, your insurance company may reimburse you for a portion of the cost (more on that below).
Important things to know about out-of-network benefits:
Out-of-network does not mean "not covered." Some insurance plans offer generous out-of-network benefits, while others do not provide any coverage for out-of-network care.
If your plan includes out-of-network benefits, reimbursement is typically based on your plan's allowed amount (the amount your insurance company considers eligible for reimbursement), rather than your therapist's full fee.
Many PPO plans include out-of-network benefits, while most HMO plans do not. However, every plan is different, so it's always a good idea to check your specific benefits with your insurance company.
Why are you an OON provider?
This is a common question, and one I understand well. It was a decision I made thoughtfully and with great care.
Making therapy as accessible as possible is important to me. I also recognize that being an out-of-network provider can create financial barriers for some people, which is why I reserve approximately 25% of my available appointments for reduced-fee patients.
Ultimately, my decision came down to providing the type of care I believe best serves my patients. When therapists are in-network with insurance companies, treatment is often subject to insurance requirements. Depending on your plan, this may include the need for a mental health diagnosis, limits on covered sessions, or requirements that services be considered medically necessary in order to continue coverage.
Working outside of insurance allows us to make treatment decisions based on your unique needs and goals rather than your insurance plan's coverage criteria. It also gives us greater flexibility to determine the pace, frequency, and approach to therapy together, while offering an added level of privacy since I do not need to submit treatment information to your insurance company for payment.
To help make out-of-network care more affordable, I partner with Mentaya, a service that can quickly check whether your insurance plan includes out-of-network benefits and estimate how much you may be reimbursed. While it's always a good idea to confirm your benefits directly with your insurance company, Mentaya can be a helpful first step in understanding your coverage.
5 Questions to Ask Your Insurance Company
1. Do I have out-of-network benefits for outpatient mental health services?
Be sure to use the phrases "outpatient mental health" and "out-of-network" when asking about your benefits.
2. What is my out-of-network deductible, and have I met it?
Some insurance plans have a separate deductible for out-of-network services, so it's helpful to know whether yours has been met.
3. After my deductible is met, what is my out-of-network coinsurance?
For example, you might ask, "What percentage do you reimburse after my deductible is met?" or "What percentage am I responsible for paying?" Insurance representatives often explain coverage in these terms.
4. Are outpatient psychotherapy services covered out-of-network? Are there any visit limits?
Some plans limit the number of covered visits or have different coverage rules for various types of mental health services. If the representative can't give you a clear answer, ask whether there's another department or resource that can.
5. Does my plan cover out-of-network telehealth therapy?
Coverage for telehealth services can vary. Even if you plan to meet with me in person, it's worth asking about telehealth coverage in case you ever need to switch a session to virtual.