Using Out-of-Network Insurance Benefits to Get reimbursed for Session Fees
Questions & Answers...
Does HFT accept my insurance?
If you have out of network (OON) benefits/coverage, then you may be eligible to receive direct reimbursement payments from your insurance provider after paying for services upfront. Clients are responsible for payment of the session fee at the time of services. I do not bill insurance directly (at the time of services). I am considered an out-of-network provider.
What is out-of-network insurance coverage?
Some insurance plans offer out-of-network benefits/coverage meaning you can use your insurance to see providers not in-network (or not contracted) with your insurance plan. If you have out-of-network benefits/coverage and would like to use insurance to cover the cost of therapy, you would submit statements to your insurance and be directly reimbursed by them.
How do I check my health insurance benefits?
For the most comprehensive and accurate understanding of your health insurance plan coverage and benefits, you should contact your health insurance provider directly.
Once I've confirmed my OON benefits, how do I use my insurance to cover the cost of therapy?
Clients with out of network insurance coverage pay for therapy on the day of services and then submit statements for reimbursement directly to their insurance provider. The insurance provider then sends payment directly to clients.
How much can I expect to be reimbursed?
For those with out of network coverage, once you have met your out-of-network deductible, you can expect to receive reimbursement for a percentage of the session fee. The amount or percentage amount varies and depends on your plan and provider. If you are relying on insurance covering a portion of the cost of therapy, I recommend confirming benefits and expected reimbursement amounts before the start of therapy.
What can I expect if I have a high deductible?
Your deductible is how much money you have to pay out of pocket each year, before insurance starts covering the costs (or a portion of the costs). If you have a high-deductible, you may be paying the full session fee out of pocket for the year before reaching your deductible amount. If this is the case, you can consider if you will reach the deductible amount quickly enough to benefit. Some clients in this situation decide to opt for private pay, so they can choose to see the therapist they want to see rather than an in-network therapist.
What are some key insurance concepts to understand and questions to ask my insurance provider?
When you contact your insurance provider, the following terms and questions may help you understand what to expect. 1. Out-of-Network Benefits - Does your plan cover out of network mental health services/providers? - Is prior approval or authorization required? 2. Deductible - How much is your deductible? - Is there a different deductible for in-network and out-of-network benefits? - What is the current balance of the remaining deductible? - On what date does the annual deductible restart? 3. Reimbursement - How much can I expect to be reimbursed of the total therapy session fee? - What is the protocol for submitting service statements/superbills/claims to the insurance company? - What is expected timeline of receiving reimbursement?
Do you accept Medicare and/or Medicaid insurance plans?
I am not an in network provider with any of the Washington or Oregon Medicare/Medicaid insurance plans, and therefore not able to bill them for services. Please note, Medicare/Medicaid plans do not typically reimburse clients for out-of-network providers and services. I ask all clients with Medicare or Medicaid plans receiving services at HFT to sign our "Medicare/Medicaid Private Pay Agreement" acknowledging and agreeing to client full financial responsibility for services. If you are hoping to use a Medicare or Medicaid insurance plan to cover the cost of therapy services, please feel free to request a referral to an in-network provider. I am happy to help if I can.
What are the privacy considerations when using insurance for therapy?
If you choose to submit statements to insurance, they require a mental health diagnosis which becomes part of your medical record. Some clients do not want a diagnosis or do not want this to be part of their medical record. Others may not mind having a mental health diagnosis or already have one as part of their record.
Do I have to receive a mental health diagnosis when using insurance?
Yes, it is a requirement of the insurance companies that a diagnostic code be on each claim.
