Self Pay/Out of Network Providers

Greetings all and welcome to the Out of Network Provider informational.

Thank you for taking the time to visit and view our page.  We hope you can take something useful out of our blogs!

Today we are discussing Out of Network Providers and fee for service agencies.

Every single health insurance has an “In Network” provider list.  This list is of providers who have an agreement with your healthcare insurance that they will pay a certain percentage of what that provider is charging for their services.  This also gives these insurances the power to decide how many sessions a mental health provider can provide to an individual.  If insurance “feels” that an individual has done “enough” sessions then they can reduce the payment to the provider even more or can refuse to pay for more sessions, citing it as unnecessary.  This leaves the provider and the client in a bad spot. This gives more power to the insurance company instead of the patient!

There are many reasons why individuals choose to have an Out of Network Providers.  Here are some:

You have a high deductible plan

Many insurances have a high deductible plan where you would have to pay a certain amount up front. Your deductible is an amount you must pay up front before your health insurance coverage covers any cost.  Let’s say your deductible is $5,000 and you haven’t had any other medical expenses yet, or very minimal.  You would have to pay those $5,000 or close to $5,000 for your standard copay to apply.

Your insurance has a great out of network benefits

If your insurance has great out-of-network benefits, you can be paying a minimum of 20% of each therapy session.  Yes, that means your insurance will cover up to 80% of out of network expense.  It just depends on your plan and the therapist rate. 

I know this firsthand, as our insurance covers my son’s out of network provider at 80% (I take my son to a wonderful pediatrician office that provides functional medical treatment. (gotta practice what you preach!) Check them out at https://wellrootedpediatrics.com/ )

This means depending on certain insurances and situations, using your out-of-network benefits can be MORE affordable or at least comparable to your standard copay to seeing an in-network provider!

In-network insurance providers can have a LONG wait list

We are in a very difficult time as a nation and mental health issues have skyrocketed in the past 19 months.  This has put a significant strain in our mental health community and has left many seeking mental health services.  Due to this increase in need for mental health services, in-network providers are fully booked, don’t have any available appointments anytime soon, and quite frankly just do not have the capacity to take on anymore new patients. 

If you need to see a therapist sooner rather than later, it makes more sense to seek an available appointment with an out of network provider to begin care as soon as possible.  As out of network therapist, we have gotten an influx of new patients, and we are working very hard to be available to new patients needing and seeking care as soon as possible.  

You are looking for a therapist with a specific skill set or personalized services.

There are many great in-network therapist who can provide an array of services.  But many times, specialized services are not “in-network.”

 Insurances really cripple the way we as providers can provide best care for our clients.  They make up these constraints and boxes that a provider “must check off” in order to “demonstrate” the client really needs this type of care.  Which then leaves Therapists with constraints on only providing services we can bill to insurances.  When we get rid of this insurance made constraint, we as providers are able to spend more time creatively crafting the ideal treatment for you as an individual!

In Network therapist are far away, not easily accessible

Another problem many clients have faced is that the list of in-network providers is very small, and that the nearest provider is anywhere from 25-50 miles away!  This is MIND BLOWING! 

How do insurance companies expect individuals to get treatment if it’s not easily accessible?!  Who wants to drive one hour to get to a therapy appointment, then drive an hour back?  Or let’s say these in network providers are far away, but they do not offer tele-counseling services, or your insurance plan does not cover tele-counseling at the rate the therapist is providing it for. 

Again, these insurances are creating these restrictions and constraints for you, when they  should be serving you and providing the best healthcare services available! 

Other Options- Health Spending Account/ Flexible Spending Account

Do you have a HSA or FSA account through your job?  Do they provide you with an HSA or FSA credit card?  A HSA or FSA account does cover mental health services or help cover/offset the cost for mental health treatment.  If you have an FSA or HSA, have found an out of network provider who you clicked with and meets your needs, then use those benefits to take care of your mental health needs. 

 We at LCCC do accept HSA and FSA payments.  We are here to serve YOU, the person, mind, body, and soul.  And we want you to get the services and treatment that YOU need, not what some health insurance determines YOU need.

If you are ready to dive into holistic healing, give us a call.  We will be happy to assist you in your healing journey!