Using your Out of Network Benefits to pay for Therapy

Out-of-network insurance benefits can help make therapy more affordable. Unfortunately, new therapy clients often don’t understand that’s an option. Or, they truly find the process confusing and overwhelming. Insurance companies don’t always make their processes easily understood, unless you’ve spent some real time figuring it out (read: hours of your life spent on the phone).

To help you navigate the process, we put together a guide to understanding the basics so that you can get quality and affordable therapy, and get paid.

Need help covering the cost of therapy?

Out-of-Network benefits are the portion of costs that your insurance company will cover for services that are provided by someone who is not on their panel. These benefits can vary significantly from plan to plan (not just company to company). Not all plans even offer out-of-network benefits. Generally speaking, HMOs do not offer out-of-network coverage while PPO, EPO and POS plans do. 

Finding out about your specific coverage will help you make informed decisions about how to fit therapy into your budget. Planning ahead for expenses tends to be very useful when decreasing anxiety around beginning therapy.

Here are the steps to follow for Accessing Out of Network Benefits:

1. You’ll want to find out about your specific coverage.

   Call your insurance provider using the number on the back of your insurance card. If there is a number specific to “behavioral health” or “mental health”, use that one. Otherwise, call the main benefits line.

2. Once you are speaking with the proper representative ask these 4 questions:

   1. Do I have out-of-network coverage for therapy? If so, do I have a deductible to meet before my coverage kicks in?

   2. What percentage of each session will be covered? Is there a maximum allowed amount?

   3. Is there a limit to how many sessions I can access in a year?

   4. Will my benefits cover online therapy or only in-person services?

   5. How do I submit a superbill to my insurance provider? (See below for what a superbill is.)

3. Understanding the lingo that your insurance company may use

   Understanding some of the lingo that the insurance company will use is super helpful as well. Because after you figure out your benefits, you’ll want to ask your therapist or their admin staff for a Superbill.

   1. A Superbill is is essentially a very detailed receipt that provides your insurance company the information it needs to process a claim for reimbursement. The client pays the therapist for services up front, requests the superbill from the provider, submits the superbill, and then is reimbursed directly by the insurance company. Usually they’re reimbursed through a check that will come in the mail.

   2. Your insurance company will most likely have a brief form for you to complete when submitting your superbill for reimbursement electronically or via mail. Typically, you have 1-2 years to submit these. But of course the sooner you submit, the sooner you get paid!

Now, what if when you call your insurance they say you don’t have Out of Network Benefits?

Here is plan B:

• Use your FSA or HSA benefits: Therapy is generally a covered service that you can use your Flexible Spending Account or Health Savings Account funds to pay for. Provide this card to your provider or their admin staff to process for any treatment you receive.

• Find an in-network therapist: Most therapist databases offer the option to sort by insurance provider to narrow down your options. (Our therapists on our team do have 3 insurances they take including Aetna, United Healthcare and Cigna). Or, use websites like Psychology Today to find someone in network.

• Ask about reduced fee and sliding scale options: Many therapists reserve a portion of their caseload for reduced fee options for people with financial need. Many of our provisionally licensed therapists and interns offer reduced pricing options as well. Open Path Collective is a great resource for finding a therapist from $30-60 per session.

If you still have questions, please reach out to our admin team! They will be happy to help you navigate your way to a provider that works for your therapy needs.

begin therapy in florida or colorado

At WellMinded Counseling we have therapists licensed in the state of Florida and Colorado. We also offer online therapy services so we are able to see clients located anywhere within those two states. If you’re interested in getting set up with one of our therapists, you can follow these steps:

1. Contact our counseling office and schedule a free 15 minute consultation

2. Meet with one of our caring therapists and learn more about our therapy services

3. Begin therapy and start working through the challenges in your life

SERVICES OFFERED AT WELLMINDED COUNSELING

The therapists at our counseling center in Tampa, FL and counseling center in Denver, CO see clients of all ages and addresses a wide variety of mental health concerns. WellMinded offers the following counseling services:

• Substance Abuse Counseling

• EMDR

• Couples Therapy

• Relationship Counseling

• Anxiety Treatment

• Depression Treatment

• Trauma Treatment

• Teen therapy

• Self-Esteem Counseling