The Basics of Out of Network Mental Health Benefits
Be You Psychotherapy is an out of network mental health private practice. You may have heard the term “out of network” before, but what does it really mean? In this blog post, we will discuss the basics of out of network mental health benefits as well as how to go about determining your own out of network benefits.
What are Out of Network Benefits
Health insurance can be extremely confusing, so first, we need to discuss what seeing an out of network (rather than in-network) therapist actually means. An “in-network therapist” means they are paneled with a health insurance company and have agreed on a reduced rate for their clients. This means the client would not be paying the therapist’s full rate; the client would pay a copay. The health insurance company then pays your therapist a set amount per session after the session.
An out of network therapist is someone who is not paneled with an insurance company. This means the therapist gets paid in full by the client after each service. The client can then get reimbursed by their health insurance company based on their out of network mental health benefits. There are many benefits to seeing an out of network therapist. They may be able to provide more specialized, niche care to their clients rather than an in-network therapist who has to follow more rules and regulations based on the paneled health insurance company. While you are responsible for paying your therapist’s full fee yourself, you may be eligible for reimbursements from insurance. We break down what this means below so you can maximize your insurance benefits.
Out of Network Benefits Terms
Deductible: A deductible is the amount of money you have to pay before you are eligible to your benefits, and therefore, receive reimbursements.
Coinsurance: This percentage represents the split between patient and insurance responsibility based on their “allowed amount” for the service. This percentage will come into play once you hit your deductible
Allowed Amount: This is the fee that the health insurance company bases their out of network mental health benefits on. This may mean that the per session fee that your Be You Psychotherapy psychotherapist charges could be different from what the health insurance bases their benefits on. For example, if your health insurance company’s allowed amount for mental health services is 100 dollars per session, the percentage that you will get reimbursed will be based off of 100 dollars not your Be You Psychotherapy therapist’s fee per session.
Out of Pocket Max: The amount of out of network payments you will need to hit to be eligible for 100% reimbursement.
The above definitions are basic terms when it comes to understanding your out of network mental health benefits. Be You Psychotherapy suggests to confirm these definitions with your health insurance company as well as head to the below links to learn more details on these terms as well as additional terms to know in regards to your out of network benefits
How to Determine Your Out of Network Benefits
There are a few ways to go about this. The first step is to head to Be You Psychotherapy’s website to fill out the insurance verification form. Once you have filled out this form, a Be You Psychotherapy psychotherapist will verify your out of network benefits as a courtesy to you. Once they locate the data, they will provide you with your coinsurance as well as your deductible. Be You Psychotherapy always suggests calling your health insurance company to confirm that what they receive is up to date and correct information. The clinicians at Be You Psychotherapy also suggest asking about your allowed amount and out of pocket max so you have a full understanding of your reimbursement eligibility.
Below are some helpful steps on how and what to ask your health insurance company:
Step 1. Call your health insurance provider by using the member services number on the back of your health insurance card.
Step 2: Confirm that your plan offers out of network mental health benefits, specifically for therapists in private practice.
Step 3: Confirm how much your deductible is as well as how much of it has been met so far. This is so you know how much still needs to be met.
Step 4: Ask about what percentage of sessions your health insurance will cover per mental health session once you have met your out-of network mental health deductible. This will confirm how much you will be reimbursed for each session by a Be You Psychotherapy psychotherapist.
Step 5: Confirm how many mental health sessions per year are covered.
Step 6: Ask what your plan's out-of-network out-of-pocket maximum is. This question is asking the amount of out of network payments you will need to hit to be eligible for 100% reimbursement.
Step 7: Ask how you get reimbursed / submit a claim for reimbursement. Ask how many days it takes for the claim for reimbursement to be processed and for the reimbursement to be sent to you. (Alternatively, you can use Reimbursify- a third party service that assists you in submitting your claims for you. If you are interested in this, ask your Be You Psychotherapy Psychotherapist more about how we can help you get this assistance at no cost to you!)
We understand that Out of Network benefits can be confusing and hope this blog post creates clarity on what out of network benefits are and how you can use them to get reimbursed on your psychotherapy sessions. As mentioned previously, if you are curious what your out of network benefits are, feel free to fill out Be You Psychotherapy’s insurance verification form so you can begin working with one of our psychotherapists today!
