Mikah Watford, LPC, LCDC on Apr 05, 2023 in Life Transition
Whether you have insurance or plan to pay for therapy on your own, funding your treatment can be the most daunting part of getting started. Health insurance is complicated, and it’s hard to know where to start with other resources. As a therapist who has a background in both insurance and case management, I have unique insight on how to fund your treatment.
Utilizing Your Insurance
Choosing a Provider
You typically have two levels of benefits: in-network and out-of-network. In-network, simply put, means that the therapist has an agreement to work with your insurance company. Because of this agreement, the insurance company typically covers more of the cost, leaving you paying less.
The easiest way to find therapists who are in-network with your insurance is to contact your insurance company directly. You can call the member number on the back of your card, and many companies have easy-to-use websites where you can look up therapists. You can then google the names of the providers listed to learn more about them.
You can also search directories such as Psychology Today, Therapy Den, Alma, Monarch, and Headway to identify network therapists. The benefit of these platforms is that you can simultaneously search other criteria such as experience, location, and types of therapy provided. This allows you to find a good fit fiscally and clinically in one search.
Providers do sometimes go out-of-network, so asking if the therapist is in-network with your insurance is one of the first questions you should ask when making your appointment. If you have any doubts, your insurance company is the best resource for this information. Typically, this information is readily available on your insurance’s website.
When you book your first session, you can ask for the verification of benefits information before your first appointment. This will tell you how much the insurance will cover and how much you are responsible for. Ultimately, understanding your benefits is your responsibility. The therapist’s office may not have the most updated information, so it is best to ask your insurance company directly about your coverage.
Typically, you can find your “benefits” (how much your insurance will cover of your expenses) on your insurance's website where you searched for in-network providers. You will find my blog post about understanding your insurance coverage information helpful.
In my practice, we partner with a few billing platforms (such as Alma) that make verifying your coverage and understanding your benefits fast and easy. Either the client or our administrative professional enter your insurance details (full name, DOB, insurance company, ID number, and group number). Then, within just a few hours, both the client and our team receive an email with what your insurance covers and what you can expect to pay each session.
Any therapist that is not contracted (in-network) with your insurance is considered “out-of-network.” Your insurance will likely still cover some of the expense, but not as much as with an in-network provider. There are reasons you may choose to see an out-of-network therapist. For example:
• There are no in-network providers in your area that meet your needs (availability, location, in-person, or telehealth).
• You want to see a specific therapist based on skill (specializes in a diagnosis or treatment that you need).
Depending on the situation, you may be able to call your insurance company and ask for an exception or a “single case agreement.” This means that the insurance company acknowledges you have special circumstances and need to see the out-of-network provider. In these cases, the insurance company may agree to pay at the in-network rate (meaning you pay less for your therapy).
If you choose to see an out-of-network provider and do not have a special agreement with your insurance company, you can still see that provider. Typically, if the provider is out-of-network, they will provide you with a receipt called a “super bill.” You will pay your therapist's office for your session and then submit the super bill and a claim for reimbursement to your insurance company. This can be a cumbersome process.
Make Using an Out-of-Network Therapist Easy
Submitting your own out-of-network claim can seem intimidating. Luckily, a platform has emerged to take the process of submitting out-of-network claims off your hands. Advekit bills the claim to your insurance company and only charges you your portion. No mailing claims or waiting for reimbursement. After filling out a 30-second questionnaire, you will receive an email explaining your out-of-network insurance coverage.
Example: Your out-of-network therapist charges $150 for the session. Typically, you would pay the $150 to your therapist, submit the claim with the superbill, and wait for reimbursement.
With Advekit, if your insurance coverage is 90%, they would charge you $15 and bill the rest to your insurance.
Learn more about this resource at Advekit.com.
No Out-of-Network Coverage
Not often, but occasionally, an insurance plan may not offer out-of-network coverage. In these cases, it is appropriate to ask the provider if they offer a sliding scale. This means a reduced rate for your sessions based on your ability to pay for treatment. Some therapists accept your word that you will need a sliding scale; others will require you to complete an approval process. If you would like to see an out-of-network provider, please also see the post about covering therapy without insurance.
Health Savings Account
Whether you select an in- or out-of-network therapist, you can use an HSA to pay for your therapy. A health savings account, or HSA, is an account you use to pay for qualified medical, pharmacy, dental, and vision expenses and save on taxes. This can include the full cost of a session, deductible, copay, or any other related expense. Almost all therapists accept HSA cards as a form of payment. HSAs are typically an employer benefit that you elect during open enrollment.
After Your Session
Whether an in-network or out-of-network therapist meets your needs, you will receive an “explanation of benefits” shortly after the claim is processed to explain how the claim was paid and what was covered. Reviewing this after your first session is helpful in ensuring you are making the most of your coverage. Selecting a therapist can include weighing costs, representation, skill, and other factors to find the best clinician for you.
Mikah Watford, LPC, LCDC
Advanced Clinical Trauma Specialist
Founder and Clinical Director of MW Psychotherapy