Questions to Ask Your Insurance Company to Use an Out Of Network Provider

  • Does my health insurance plan include mental health benefits?
  • Do I have Out-Of-Network (OON) mental health benefits?
  • Do I have a deductible to meet before benefits kick in for out of network providers; if so what is it, and has I met it yet?
  • How is reimbursement determined – what (if any) is my co-insurance once I reach my annual deductible?
  • Are there any limitations to the type of mental health services covered?
  • Do I need written approval from my primary care physician in order for services to be covered?
  • Is there a limit to the number of sessions per calendar year? If so, what is the limit? (Some providers give approval for a certain number of sessions and request re-authorization after that number has been met.)
  • Are there any documents I need to submit along with my “statement of services receipt”? (generally, no.)

What is the benefit of private pay? Why wouldn’t I use insurance if I have it?

People choose to do private pay for a number of reasons. The typical reasons people don’t or can’t use their insurance are: poor insurance coverage or limitations; the desire to protect their privacy; and the right to determine who to work with without limitation.

Generally speaking, billing insurance opens the door to their involvement with your treatment such as requiring a formal diagnosis, note and treatment reviews, and a list of who you can work with. They may also have restraints on the type of therapies you can participate in and how many sessions you can receive. Insurance is great, however, there are times that the limits it places does not meet your needs.

I took insurance for the first 10 years of my practice, however, over time I have wanted more control over my case load and flexibility regarding treatment approach and time in order to more effectively adjust to my client’s needs. I reserve a number of sliding scale appointments so that I can remain accessible to a variety of people and I help match people to services when I can’t meet their needs or when I am full.