If you are starting to look for a therapist, here are 8 reasons you may want to consider seeing an out-of-network therapist.
- You are looking for a therapist with a unique skill set
While many therapists are qualified to treat common challenges- such as anxiety or depression – if you are interested in working with a specialist to address a specific challenge, you should consider looking out-of-network.
Private pay therapists often have more specialized practices. So, if you come across a therapist whose skills directly speak to your needs, it’s worth reaching out.
Picture your dream therapist. If you imagine one of the following – or someone with a similarly niche expertise – consider looking outside of your insurance network:
- A therapist of color
- An eating disorder therapist
- An insomnia specialist
- A cognitive behavioral therapist (CBT) specialist
- An EMDR Therapist (certified)
- A therapist who specializes in working with LGBTQ couples.
- You have a high deductible plan
A deductible is the amount you have to pay upfront before your insurance coverage kicks in. If you have a $6,000 deductible and you haven’t had any other medical expenses yet in the year, you are responsible for paying up to $6,000 in therapy session fees out -of -pocket before your standard copay applies. This is a case where seeing an in-network therapist and out-of-network therapist can accrue effectively the same cost.
- You have good out-of-network benefits
If you have good out-of-network benefits, your insurance company may reimburse you as much as 80% of each session fee, depending on your plan and the therapist’s rate.
This means that in some situations, using your out-of-network benefits can actually be more affordable or comparable to your standard copay to see an in-network therapist.
- You want highly personalized services
If a therapist isn’t constrained by only providing services they can bill to an insurance company, they are often able to spend more time and creativity crafting the perfect treatment plan for you. Especially if you would like to receive mental health services for a long period of time, this extra attention may benefit your progress.
Out-of-network therapy opens doors for out-of-the-box treatment
Out of network therapists can offer longer or more frequent sessions than insurance might cover. You can also explore out of the box solutions.
For example, if you are struggling with eating challenges, an out of network therapist might with you to the grocery store or help you cook and eat healthy meals. These are services that an in-network therapist would not be able to bill (so they likely wouldn’t be offered)
This is also true of services that are not intended to address a diagnosable mental health condition, such as couples counseling.
- You want to combine medication management with talk therapy
Some psychiatrists offer both psychotherapy and medication management, which allows for a more comprehensive understanding of your mental health needs before prescribing.
These services are often private pay, but they offer great convenience and highly coordinate care.
- You don’t wish to use insurance benefits
Privacy for your family and/or parents
If you are on your parent’s insurance plan and are uncomfortable with them knowing you are seeing a therapist, you might consider paying out of pocket.
Note: since this also means you can’t use out of network benefits session fees could get steep. Look for a therapist wo offers a sliding scale – If you have financial limitations and explain the situation, some therapists are able to offer reduced rates.
Privacy from your health insurance company
In order for your insurance to pay for therapy sessions, therapists are required to provide the company information regarding your sessions, including a diagnostic code. If you don’t want your insurance company to have access to any information about your mental health, consider out of network option.
- You don’t want to wait to start therapy
In cities such as Boston, San Francisco, New York and Washington DC, many therapists choose not to accept insurance because they fill their caseloads easily and quickly.
Especially for less-known insurance plans, it can be very difficult to find a therapist who is in network and accepting new clients. If you limit your search by insurance, you may have to spend months on a waitlist before seeing a therapist.
- You found a great match!
At the end of the day, your relationship with your therapist is one of the most important aspects of the healing process.
If you only consider in-network therapists, you may eliminate therapists who would be a really good fit for you and maybe help you feel better faster.
Choosing an in-network therapist who doesn’t make you feel comfortable or specialize in the areas you are struggling with solely because they are in network is a waste of money (and not to mention time!). Prioritize the personality fit and you will find a great match – your mental health is worth it.
If you are working with a therapist, you really like and your insurance company changes (you graduate school, you get off your parent’s insurance, you switch jobs) don’t panic! Depending on your insurance plan, it may still be affordable to see your therapist using out of network benefits.
Need help navigating health insurances or using out of network benefits?
Take the following steps
- Check your out of network benefits. These are typically in the summary of benefits that is included in a member information packet or on your insurance company website.
- Call your insurance company to verify: The best way to be absolutely sure of your benefits is to call your insurance company member services line and ask:
What is my out of network deducible for outpatient mental health?
How much of my deductible has been met this year?
What is my out of network coinsurance for outpatient mental health?
Do I need a referral from an in-network provider to see someone out of network?
How do I submit claim forms for reimbursement?
- Ask you therapist for a superbill: When you are looking for a therapist, ask if they will be willing to submit claims to your insurance company for reimbursements. Typically, they will provide a document called a superbill that you send directly to your insurance company at the end of each month which will detail how many sessions you have had and the total fee.
- Receive reimbursement! You will need to pay your therapist their entire session fee at the time of service, but depending on your specific plan, your insurance company will mail you a check to reimburse a portion of the cost.a