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Understanding "Out of Network" Therapy and Insurance

Updated: 3 days ago

I do not accept insurance. Learn how you may be able to get part or all of your session fee covered through your "Out of Network" benefits.


In this article, you will learn more about how I operate as a therapist in regards to insurance. I do not accept insurance directly. I have several reasons for this, outlined below.


Reasons Why I Do Not Accept Insurance

  1. Insurance companies generally want to dictate aspects of your sessions. They usually want to determine how long your sessions are, and often limit sessions to 50 minutes

  2. Insurance companies also tend to have rules about how many sessions you are allowed to have in a year, and may stop covering your therapy after a certain amount of sessions

  3. They often have a short list of therapeutic modalities they allow to be covered, such as Cognitive Behavioral Therapy. The methods I use at Alternative Therapy STL often do not fall underneath their list of therapies

  4. Many insurance companies will even want personal information about you, such as a diagnosis and even highly personal details that you reveal in sessions!

  5. Insurance companies tend to require a lot of paperwork and documentation from the therapist. This increases administrative work for me and reduces time I could be spending with you, pursuing continuing education to help you even more, and taking care of myself so I can be 100% present and energized with you.

For these reasons, I have elected not to become paneled with any insurance companies. I hold the personal information you share with me to be highly confidential and sacred. I also enjoy being able to offer diverse and unique modalities that I have found to be particularly enjoyable and transformative. Additionally, I’ve been intentional about the 65-minute length I hold for sessions, since this timeframe allows for deep work and integration, without rushing.


The Benefits of Private Pay Therapy

  1. You are not limited to a brief list of in-network therapists provided by your insurance company. You can instead choose a therapist you really “click” with (dare I say me?!) ;)

  2. You get to have session lengths that are best suited to the type of therapy you are doing, that allow for deep work, processing, and integration, without feeling rushed in a 50-minute timeframe

  3. You get to experience cutting-edge, new, holistic, and/or alternative modalities that insurance companies may not know about or cover yet, such as Internal Family Systems, Depth Hypnosis, Shamanic Counseling, and Transpersonal Counseling

  4. You do not have to reveal your personal information, such as the content of your sessions, with your insurance company and are able to maintain better privacy

  5. You can received specialized help, instead of generic help, and benefit from therapy that is personalized to you

  6. You are welcome to see a therapist, even if you do not qualify for or want a diagnosis on your file. My practice is non-pathologizing, and you are not required to have a diagnosis (although if you want to go through a diagnostic process, you are welcome to talk to me about this!)

A Potential Workaround to Insurance Coverage: Out of Network Benefits


Even though I do not accept insurance directly, you may find a loophole to get your therapy sessions covered by insurance with your “out of network” benefits. “Out of Network Providers” are licensed providers, such as myself, who are not paneled with insurance companies. Some insurance companies allow you to see OON providers and provide great out-of-network benefits, while others do not. This is something you would need to call your insurance company to check. OON benefits allow you to choose a specific provider you really want to work with, pay the provider directly for the sessions, and be reimbursed by the insurance company, usually in the form of a check.


How to Coordinate Out of Network Reimbursement


If you want to see if this option is available to you, I recommend checking with your insurance company sooner rather than later. Before your initial consult session is best! Please understand that determining your OON benefits is your responsibility. While I will not call your insurance company for you, to make the process easier, I have made a list of questions below that you can ask to make sure you cover all of your bases.


Questions to Ask When You Call your Insurance Company


  1. Do I have mental health insurance benefits that allow for out-of-network services?

  2. Do I have a deductible that must be met first before you pay for counseling? How much has been met? (You can also ask them what a "deductible" is if you do not know what that means).

  3. How many OON mental health sessions per year does my health insurance cover? Is there a limit?

  4. Do my counseling sessions need to be under a specific billing code? (The most common billing code is 90834 for 50-minute sessions, but I use 90837 for 65-minute sessions).

  5. Does my plan require that I have pre-authorization prior to sessions with a therapist? (If so, please have that information before the first session).

  6. Do I need a diagnosis to be reimbursed? Does this diagnosis need to be on my superbill in order for it to qualify for reimbursement? (If the answer is “yes,” please let me know this so I can arrange it. We will need to do this close to when we begin therapy to avoid delays in coverage).

Next Steps if You Have OON Benefits


Once you’ve determined if your insurance company offers out-of-network benefits, please let me know so that I can arrange anything I need to, such as a diagnosis and setting you up with superbills. A "superbill" is a fancy medical invoice that includes my professional identifying numbers and the billing code and cost of the sessions. You can then submit this paper to your insurance company to receive reimbursement, usually in the form of a check mailed to you. (If you do not receive a superbill from me automatically, you can ask for one at any time and I will send it to you!)


As a reminder, even if you have OON benefits, I will not be speaking or coordinating with your insurance company. You will pay me for sessions directly, and as long as you submit the superbill correctly, you will receive reimbursement from them.


I hope you found this article helpful!

-Emma


P.S. if you're ready to book a consultation session, you can do so on this page.


#insurance #outofnetwork

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