By Edie Stark

Blog Take-away:

Navigating the complexities of health insurance can be daunting, especially when it comes to mental health care. Many individuals and families find that their preferred therapists are not in-network, which can lead to significant out-of-pocket costs. However, understanding and utilizing your out-of-network benefits can make therapy more affordable and accessible. In this blog post, we'll explore tips and strategies for making the most of your out-of-network benefits for therapy services.

Tip 1: Review Your Insurance Policy

The first step in utilizing your out-of-network benefits is to thoroughly review your insurance policy. Look for specific details about:

• Deductibles: The amount you need to pay out-of-pocket before your insurance starts covering out-of-network services.

• Co-insurance: The percentage of the therapy cost that your insurance will cover after you’ve met your deductible.

• Out-of-pocket maximums: The total amount you will need to pay out-of-pocket in a year, after which your insurance covers 100% of the costs.

• Reimbursement rates: The amount your insurance will reimburse you for out-of-network services.

This information is typically found in your insurance plan’s summary of benefits or policy document.

Tip 2: Verify Coverage with Your Insurance Company

Before starting therapy with an out-of-network provider, call your insurance company to verify your coverage. Ask specific questions to understand how much they will reimburse for therapy sessions and what documentation you will need to submit claims. Questions to consider include:

• What is the out-of-network deductible and how much of it has been met?

• What percentage of the therapy cost is covered after meeting the deductible?

• Are there any limits on the number of sessions covered per year?

• What information is required for claim submissions (e.g., itemized receipts, treatment codes)?

Having this information upfront will help you anticipate costs and avoid surprises.

Tip 3: Choose the Right Therapist for You

When selecting an out-of-network therapist, consider the following:

• Licensing and credentials: Ensure the therapist is licensed and has the appropriate credentials, as insurance companies often require this for reimbursement.

• Specialization: Choose a therapist who specializes in the issues you are seeking help with, such as anxiety, depression, or eating disorders.

• Fees: Discuss the therapist’s fees upfront and whether they offer sliding scale options based on your financial situation.

Finding a therapist who fits your needs and budget is crucial for effective therapy.

Tip 4: Keep Detailed Records

Accurate and detailed records are essential for submitting out-of-network claims. Keep the following documentation organized:

• Receipts: Obtain itemized receipts for each therapy session, including the date, duration, and cost of the session, as well as the therapist’s name and credentials.

• Superbills: A superbill is a detailed invoice provided by your therapist that includes all the necessary information for insurance reimbursement, such as diagnosis codes, treatment codes, and the therapist’s tax ID number.

• Insurance Forms: Complete any necessary insurance claim forms required by your insurer. These forms often ask for details about the services received and the provider

Tip 6: Follow Up with Your Insurance Company

Insurance companies can sometimes be slow or make errors in processing claims. Keep a record of when and what you submitted, and follow up with your insurance company regularly to check on the status of your claims. If a claim is denied, ask for a detailed explanation and the steps needed to appeal the decision. Be your own advocate!

Tip 7: Utilize Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs)

If you have an HSA or FSA, you can use these pre-tax funds to pay for therapy services. This can effectively reduce your overall costs by using pre-tax dollars. Check with your HSA or FSA administrator to ensure that therapy expenses are covered and understand the documentation required for reimbursement.

Tip 8: Educate Yourself on Mental Health Parity Laws

Mental health parity laws require insurance companies to provide coverage for mental health services that is comparable to physical health services. Understanding these laws can help you advocate for better coverage and address any discrepancies in how your insurance handles mental health claims. If you believe your insurance company is not complying with parity laws, consider filing a complaint with your state’s insurance commissioner or seeking legal advice.

Final Thoughts…

Utilizing your out-of-network benefits for therapy services can significantly reduce the financial burden and make quality mental health care more accessible. By understanding your insurance policy, verifying coverage, choosing the right therapist, and keeping detailed records, you can navigate the reimbursement process more effectively. Remember, investing in your mental health is one of the most important steps you can take for your overall well-being, and leveraging your out-of-network benefits is a crucial part of that investment.

Our Services:

Stark Therapy Group offers therapy for all types of eating disorders, including Anorexia, Binge Eating Disorder and Bulimia. We offer a 3-tiered family based support for teens in eating disorder recovery. We treat anxiety, depression and general mental health conditions. We offer 3-tiered family based support for teens with general mental health issues. We also offer couples therapy. We would love to help you on your mental health journey. Reach out today for a free consultation!