Using Out-of-Network Benefits for Mental Health Care
Did you know that you can still see a provider that is not in-network with your insurance? Below is the letter we give everyone explaining how to use out-of-network benefits. Please call if you have any additional questions: 719-465-0900
Hi there! And thank you for your interest in working with Hope Mountain!
You’ve received this letter because we are actually not in-network with your insurance company or we think it might benefit you to not use your insurance directly. We work with clients insured by many insurance companies on an out-of-network basis. Our licenses, training, and education qualify for out-of-network reimbursement. This means that most insurance plans allowing members to go out-of-network for mental health will reimburse you for our work, according to the payments they allow.
Benefits of using out-of-network vs. in-network benefits:
For you: You can pick a therapist that suits your needs (specializes in what you need; is close to home, and fits your personality) and not merely because they’re on the list and available.
It’s Quicker: you broaden your options. In-network providers often have long waitlists. It’s common to call 10-20 names in your insurance list before receiving a callback, only to learn the person who is calling you back does not have availability for several weeks or months.
Control: You and your therapist control your treatment goals, methods, and length (let’s face it, sometimes the people at the insurance companies that determine what therapy methods to use and for how long aren't even licensed therapists.)
Towards Deductible: If you haven't met your plan deductible you would be paying fully out-of-pocket until your benefits kicked in any way (several months possibly). Additionally, payments toward therapy services will/should count towards meeting your deductible. And there are no co-pays.
No Switching: You don’t have to switch therapists if you switch jobs, or your job switches insurance providers (starting over can be exhausting, not to mention unnecessary!)
The first step in using out-of-network benefits is to call the number on your insurance card and ask:
"What percentage am I reimbursed for routine behavioral health care out-of-network?" ("routine behavioral health care" means that you are not necessarily in crisis.)
"What is my out-of-network deductible?"
"How much of my deductible have I already met?"
Next, email Sherry (our biller) at sherry@restoringlivesproject.com to let her know what your out-of-network benefits are and how you would like to proceed. Also, she will attempt to answer any unanswered questions you may have.
If you choose to go forward with using your out-of-network benefits, each month, you can either ask your therapist to provide you an invoice or receipt for your session fees or you can get this on your own from your TherapyNotes secure client area. In either case, you present this “superbill” to your insurance company for reimbursement.
Congratulations! By using your out-of-network benefits you can finally connect with a therapist who is uniquely fit to help you and your individual needs, rather than searching merely based on whether the therapist is in-network with your insurance provider and available.