Tips and Benefits of Choosing an Out of Network Provider for Therapy!

Why Should I Pay Out of Pocket?

1. What in the world are Out of Network (OON) Benefits?

   Out of Network benefits let you pick therapists who aren't tied down by your insurance provider's network. This means you get to choose who you see based on your 'fit' with them, not just who's in your insurance network. You pay the therapist directly, and then your insurance company can reimburse you based on your coverage! You can certainly choose not to get reimbursed for individual reasons. You can opt out of having a mental health diagnosis documented in the insurance provider's records and you have more control over what information is on file. Either option can be very appealing.

2. Why go out of network?

   Choosing an out of network therapist simply means you have more options at your fingertips. It's about widening your pool of choices so you can find a therapist who fits just right with your personal needs and therapy goals.

3. How do I handle the money stuff/reimbursements?

   Many folks feel a bit unsure about handling claims and payments. Here's a breakdown to keep things super simple:

   
   

   A. Check what's covered: A quick call to your insurance provider will clarify what your plan allows.

   B. Pay your therapist: You handle this upfront, just like any other appointment.

   C. Submit a claim: Your therapist will give you all the paperwork you need to claim back what you're owed.

   D. Get your money back: Your insurance will send you a reimbursement based on the terms of your plan.

What are Some Common Worries?

1. "Therapy is not in my budget without insurance."

   A lot of folks find that the quality of personalized care they receive makes up for the upfront costs. Plus, you might get a good chunk back from your insurance anyway!

2. "It sounds like a hassle to submit claims."

   It's usually not as complicated as it sounds. Your therapist can help you with all the documentation, and there are tools like Mentaya or Reimbursify that make this process easy peasy!

3. "What if it takes a long time to get reimbursed?"

   Waiting for reimbursement can feel a bit daunting. To help ease this concern, your therapist can guide you through setting up a smooth process with your insurance, and can explore tools that speed up the claim review. Most of my clients find that the wait is much shorter than they expected.

What is a Superbill?

A detailed receipt that includes all the information an insurance company needs to consider reimbursing for healthcare services. It usually includes the provider's information, the date of service, CPT (type of therapy) codes, diagnosis codes and the cost of each service.

Helpful Tools and Resources

1. Mentaya:

   This little lifesaver simplifies the claims process, helping you keep track of submissions and cut through the red tape with ease.

2. Reimbursify:

   Another fantastic tool that allows clients to file their insurance claims with just a few taps on their smartphone. It's quick, user-friendly, and designed to get your reimbursements processed faster.

3. Thrizer:

   Offers a seamless way to manage out of network benefits by directly handling claim submissions for you!

The best advice I can offer is to ask questions when first making contact with your chosen therapist or counselor! Ask them how much assistance they are able to give you.