One of the most common questions I receive as a clinician is, “Do you take insurance?” With the cost of living rising, I totally get it. Therapy can be quite expensive! When navigating the world of insurance, knowing about in-network and out-of-network coverage can save you a considerable amount of time and money.
In-Network Coverage:
When a mental health provider or facility is part of an insurance company's network, they are considered in-network. These providers have made contracts with specific insurance companies to provide services at pre-negotiated rates.
One of the primary benefits of seeing an in-network provider is that insurance typically covers a large portion of the cost of therapy sessions, resulting in lower out-of-pocket expenses for the patient. Billing is typically handled directly between your mental health provider and your insurance, so you don’t need to be involved in the billing or payment process. Additionally, your specific insurance company will have a list of in-network providers that they can give to you, saving you time when looking for a therapist who takes your insurance. However, places that take insurance may have a long waiting list, and the in-network providers may not specialize in the type of therapy you require.
Out-of-Network Coverage:
Many therapy practices may not be contracted with your specific insurance company or may only accept private pay, meaning all payments must be made upfront by the individual receiving services. These facilities are considered out-of-network. However, depending on your out-of-network benefits in your plan, your insurance may offer help covering the cost of therapy.
For example, I saw a client who paid out-of-pocket for our sessions, and after a few months, they finally got around to calling their insurance to see if their sessions could be reimbursed or partially covered. They were pleased to learn that once their deductible had been met (which it had), their insurance would cover 75% of the cost. Just think! A $100 session would now only cost them $25 a week, saving them $300 a month! Out-of-network facilities can provide their clients with a “super bill” at the end of each month, which they can then send to their insurance company to receive the benefits or coverage provided in their plan. This allows for therapy to be much more affordable and gives you the flexibility to find a mental health provider that specializes in the type of therapy you need. While out-of-network therapy may have higher out-of-pocket costs, some people choose this option for various reasons. They may prefer to work with a therapist who specializes in a specific area, is located closer to home, or does not have a waitlist.
Conclusion:
It is important to review your insurance plan to understand the insurance’s coverage details, including deductibles, co-payments, and coinsurance rates for both in-network and out-of-network services. Therapy can be affordable with the right insurance plan, whether you are using in-network or out-of-network services. There are important considerations besides cost when choosing a mental health provider, including the type of therapy you are seeking, the qualifications and experience of the therapist, and the location and availability of therapy sessions. While in-network providers may offer more cost-effective options, you should prioritize finding a therapist who is the right fit for your unique needs and goals.
About the Author:
Emily Burnham is a Marriage and Family Therapist who enjoys working with couples and families at CLEAR Counseling. In her spare time, Emily loves to stay busy with learning new languages, writing stories, and creating videos for her YouTube channel: Elevate With Emily.
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