6 Reasons to Use your Out-of-Network Coverage when your therapist isn’t In-Network.
What you need to know about your Out-of-Network benefits
Ever wonder why people choose to go Out-of-Network when looking for a therapist rather than simply using their In-Network benefits? There are many reasons people are not simply settling for an In-Network therapist. I’ve listed some of these reasons below.
1. People are looking for trained therapists who have a Niche in treating a specific and targeted problem. They are not looking for just any therapist that treats anyone and everyone that comes their way. Some therapists for example, may specialize in treating trauma using EMDR, treating anxiety with a CBT approach (Cognitive Behavioral Therapy), or in working with clients through Video Conferencing rather than In-Office appointments.
2. People are looking for Therapy that is more personalized and Quality Driven. When you’re working with an In-Network therapist, you do not have as much freedom as you do with an Out-of-Network provider. With an In-Network provider, you may be limited as to the amount of sessions you can have during a given year or you may require authorization and/or clinical review to determine if the insurance company feels continued services are warranted. Out-of-Network providers will work with you for as long as you both decide is necessary, with less restrictions on therapy. These therapists are able to move outside of the traditional scope of therapy as they see fit. They for example, may decide that it’s best to meet in a department store vs an office session if they are working on reducing social anxiety. They may also decide to work within a longer session time than the length of time indicated under the In-Network Insurance plans.
3. Privacy is of utmost importance to many people. When using In-Network benefits, therapists are required to give a diagnosis and submit specific information such as dates of services, treatment plans and at times, a clinical review may be conducted to decide if or for how long a person can be treated. Not everyone is comfortable with having a diagnosis and disclosing their personal information to others.
4. Your Out-of-Network Coverage is just as good, possibly even better than your In-Network Coverage. If you’re someone that’s used to going with In-network providers only, then you may not know any of the specifics that apply to your Out-of-Network coverage. Many insurances will reimburse up to 80% of the session costs, which at times can be similar to a copay. You can call your insurance and ask the following questions to help you in determining whether or not to use these benefits:
· Do I have Out-of-Network Benefits?
· Do I have a deductible? If so, how much?
· How much will I get reimbursed?
· What is the address where I should send the superbill from my therapy session so that I can be reimbursed?
5. The therapist you find comes highly recommended or you’ve made a GREAT connection with the therapist. When it comes to sharing personal information, people want to work with a therapist they trust and can confide in. Some prefer word of mouth recommendations while others have learned to trust their own intuition (meaning if there is a connection, then it’s meant to be).
6. You don’t want to shop around for a therapist every time your insurance changes. You may be just starting out in your job or planning to switch jobs at some point. People don’t want to shop around for a therapist every time they have a new job. This is especially true if they’ve already found someone they work well with.
Making the choice to use your IN-Network benefits vs your Out-of-Network benefits is a personal decision which only you can decide. Look to make the best choice for yourself.
Candida Diaz, LCSW-R
Face to Face Counseling and Psychotherapy
11/11/19