How to Pay for Therapy: Using Your Out-of-Network Insurance Benefits
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At Sanctuary Counseling, we’re all about making care inclusive and accessible. So you might be curious to know why we don’t accept insurance. This post is meant to answer that question, offer clarity about the confusing world of paying for therapy, and walk you through an alternative way to use your insurance benefits.
Health insurance is one of my least favorite topics - I’m sorry, it’s true! It can be difficult to navigate, most likely by design, and hard to get clear answers. Still, clients with health insurance often want to use their in-network benefits to pay for therapy services. We get it! It can make mental health care more affordable and might make it possible to attend therapy more frequently or for longer. However, insurance companies often require counselors to use specific therapy modalities, limit the number of sessions they will pay for, and require your therapist to disclose sensitive details about your care.
Alternative Therapy’s blog “Understanding Out-of-Network Therapy and Insurance” describes some common reasons counselors don’t take insurance and the benefits of private pay therapy (Donovan). Being a private pay practice means we get to collaborate with you to pick the best-fit therapy modalities and interventions and the length of your care. It means that your wellbeing and care get to remain private. It also gives us the flexibility to offer equity fees, or lower-cost therapy spots, to clients that may not otherwise be able to access services.
Using your out-of-network insurance benefits is a sort of happy medium between private pay therapy and in-network care. The therapists at Sanctuary Counseling are considered out-of-network providers. This means that while we don’t take any form of insurance, you may still use your out-of-network benefits to receive reimbursement directly from your insurance company. They will likely still require the disclosure of some information about your care, like a diagnosis, when you attend sessions, and demographic information. But your therapist can decline to share other information about your care that you want to keep confidential.
This is how it works:
The first step in this process is to check if you have out-of-network benefits for mental health care. You’ll see some options on how to find that info in the next paragraph. When you attend a therapy session, you are responsible for paying your session fee upfront. Sanctuary Counseling will then provide you with a superbill, which is a detailed receipt that you submit to your insurance company for reimbursement of your session payments.
Let’s break down how to find out about your out-of-network benefits using a few different methods. Keep reading for step-by-step instructions on calling your insurance company, checking your benefits online, using other insurance benefits, and next steps.
Calling Your Insurance Company - The Most Direct Method
Look for the phone number for member services on the back of your insurance card or call the specific number for “mental health” or “behavioral health” if you have one.
Ask the following questions once you have the appropriate person on the line (Konter-O'Hara):
Do I have out-of-network coverage for therapy? If so, is there a deductible I have to meet before that coverage kicks in?
Do I have coinsurance? If so, how much is it?
How many out-of-network mental health sessions per year does my health insurance cover? Is there a limit?
Will my benefits cover online therapy or in-person services?
How do I submit a superbill to my insurance provider?
Checking Your Benefits Online - The DIY Route
According to Ample + Rooted, you can log on to your insurance company’s website and look for your Summary of Benefits. When you find that document, be on the lookout for phrases like “out-of-network deductible” and “coinsurance.”
What do these terms mean?
Out-of-network deductible = how much you have to pay before you can access your out-of-network benefits and be reimbursed. For example, your deductible is $300. Once you pay that amount, your insurance company will cover 100% of your services. You will have met your deductible and then be eligible for reimbursement.
This means that if you spend $600, you’ll be responsible for $300 of that and then your insurance company will reimburse you for all or a portion of the remaining $300 - usually in the form of a check that is mailed to you after you submit a claim. Keep in mind: you will still have to pay for your sessions at the time of service. Your deductible will reset at the beginning of each year but every out-of-pocket health expense you pay will go towards meeting your deductible.
Coinsurance = the part of the service fee that you will have to cover out-of-pocket. For example, if your therapist’s session fee is $150 and your coinsurance is 50%, you are responsible for $75 and your insurance will reimburse you the other $75. Your coinsurance does not activate until you reach your deductible so you will have to pay the full session fee until that time.
If your insurance company has an allowed amount, this means there is a maximum that they will pay. Let’s say your allowed amount is $120 for each session, your coinsurance is 50%, but your therapist’s fee is $200. In this case, your insurance company will only cover a max of $60 and you will have to pay $140 (Tomikawa).
If Your Insurance Does Not Have Out-Of-Network Benefits - There are still options!
If your insurance benefits include a health savings account (HSA) or a flexible spending account (FSA), you can pay for therapy with those funds. Other options include finding an in-network therapist using a therapist database that allows you to sort by insurance provider. You could also ask your therapist if they have any sliding scale spots available or check out low-cost counseling services such as Open Path Collective, Capital Area Counseling, or the YWCA. There are also therapy scholarships available through various non-profit organizations such as To Write Love on Her Arms, The Loveland Foundation for Black Women, Mental Health Liberation, Mental Health Fund for Queer and Trans People of Color, and Rise Above the Disorder.
If Your Insurance Does Offer Out-of-Network Benefits - What to do Next
If you have determined that your insurance offers out-of-network benefits, please let your therapist know so they can arrange the necessary details that may be needed to be able to provide you with a superbill. You can then submit the superbill to your insurance company to receive reimbursement. Every insurance company has a different process for submitting superbills. Some may ask you to fill out a form, some may require your counselor’s signature, and others may allow you to upload your superbill online. Make sure to get clarity about this when you contact your insurance company. Though you will be your own advocate with your insurance company and need to coordinate with them directly, your therapist can answer questions you have about this process and support you through it.
Feel free to reach out to us at Sanctuary Counseling if you are interested in starting therapy and have additional questions about using your out-of-network benefits.
References:
Donovan, Emma. “Understanding ‘out of Network’ Therapy and Insurance.” ALT Therapy STL, 10 Oct. 2021, https://www.alternativetherapystl.com/post/understanding-out-of-network-therapy-and-insurance.
Konter-O'Hara, Stephanie. How to Use Your Out-of-Network Benefits to Pay for Therapy: Advice from a Therapist - Wellminded Counseling. WellMinded Counseling – Colorado & Florida Therapy, 24 June 2022, https://wellmindedcounseling.com/therapist-blog/using-out-of-network-benefits-for-therapy.
“How to Use Out-of-Network Insurance Benefits for Therapy: Ample + Rooted Blog.” RSS, Ample + Rooted, 7 Jan. 2022, https://www.ampleandrooted.com/blog/how-to-use-out-of-network-insurance-benefits-for-therapy.
Tomikawa, Yuri, and Maggie Jordan. “Step-by-Step Guide to out-of-Network Benefits: Zencare Blog.” The Couch: A Therapy & Mental Wellness Blog, Zencare, 2 Nov. 2021, https://blog.zencare.co/guide-to-out-of-network-benefits/.
