Understanding Insurance
To Understand Why Some Psychotherapy Practices Choose To Be Out of Network With Insurance Companies, We Must First Understand How Health Insurance Works.
Health insurance is a financial arrangement that helps cover the costs of medical care. It allows individuals to receive necessary treatments without bearing the full financial burden. Here’s a breakdown of the key components and how health insurance typically operates:
1. Premiums
A premium is the amount you pay for your health insurance plan, usually billed monthly. This is a fixed cost that you must pay regardless of whether you use any healthcare services.
2. Deductibles
A deductible is the amount you must pay out-of-pocket for healthcare services before your insurance starts to cover costs. For example, if your deductible is $1,000, you’ll need to pay this amount in medical expenses before your insurance kicks in.
3. Copayments and Coinsurance
Copayment (Copay): This is a fixed fee you pay for specific services at the time of the visit (e.g., $20 for a doctor’s appointment).
Coinsurance: This is the percentage of the costs you pay after you’ve met your deductible (e.g., if your coinsurance is 20%, you pay 20% of the service cost while the insurance covers 80%).
4. Out-of-Pocket Maximum
This is the maximum amount you will pay in a plan year for covered services. Once you reach this limit, your insurance will cover 100% of your healthcare costs for the rest of the year.
5. Network Providers
Health insurance plans often have a network of doctors, hospitals, and other providers. If you receive care from an in-network provider, your costs will typically be lower. Out-of-network providers may result in higher costs or no coverage at all, depending on your plan.
6. Covered Services
Insurance plans cover a variety of services, but what is included can vary significantly. Commonly covered services include:
Preventive care (e.g., annual check-ups, vaccinations)
Emergency care
Hospitalization
Prescription medications
Mental health services (like psychotherapy)
7. Claims Process
When you receive medical care, the provider submits a claim to your insurance company for reimbursement. The insurance company then reviews the claim and pays the provider based on your coverage terms, deductibles, and coinsurance.
8. Exclusions and Limitations
Every health insurance plan has exclusions—specific services or treatments that are not covered. It’s important to read your policy to understand these limitations.
9. Annual Enrollment Periods
Most health insurance plans have designated enrollment periods, typically once a year, when you can sign up for or change your coverage. Special enrollment periods may occur due to qualifying life events (e.g., marriage, birth of a child).
Why Some Psychotherapy Practices Choose to Be Out of Network with Insurance Companies
When seeking therapy, many people may notice that some psychotherapy practices are out of network with insurance companies. This can raise questions and concerns, particularly about the affordability and accessibility of mental health services. Understanding the reasons behind this choice can help you make informed decisions about your care.
1. Focus on Quality of Care
One of the primary reasons some therapists choose to operate out of network is the desire to prioritize quality over quantity. Insurance reimbursement rates are low, which may lead providers to see more clients in order to meet financial demands. By remaining out of network, therapists can dedicate more time and attention to each client, fostering deeper therapeutic relationships and better outcomes. The Seattle Counseling Center intentionally keeps clinicians case levels low, so you can be guaranteed to receive personalized and attentive care.
2. Greater Flexibility in Treatment
When therapists are not bound by insurance regulations, they have greater flexibility in how they approach treatment. This allows for:
Customized Treatment Plans: Therapists can tailor sessions based on individual needs without adhering to specific insurance guidelines.
Longer Sessions: Providers can offer extended sessions when necessary, which may not be reimbursed by insurance.
Diverse Therapeutic Approaches: Therapists can integrate various modalities without worrying about what insurance will cover.
3. Privacy and Confidentiality
Insurance companies often require detailed information about diagnoses and treatment plans for reimbursement, which can compromise client privacy. By opting out of network, therapists can maintain a higher level of confidentiality, allowing clients to feel more secure in sharing personal information.
4. Avoiding Insurance Hassles
Working with insurance can involve significant administrative burdens, including pre-authorization requests, claim submissions, and denials. By staying out of network, therapists can minimize these hassles, focusing more on providing care and less on navigating insurance bureaucracy.
5. Control Over Fees
Out-of-network practices set their own rates, which can often reflect the quality and depth of care provided. While this may mean higher out-of-pocket costs for clients, it also ensures that therapists are compensated fairly for their expertise and the time they invest in their work.
6. Encouraging Client Commitment
Some therapists believe that clients who pay directly for services may be more committed to the therapeutic process. Without the filter of insurance, clients often have a clearer understanding of the value of their investment in therapy.
7. Improving Accessibility for All Clients
By setting fees based on their own standards, therapists can often provide sliding scale options or reduced rates for those who need financial assistance, ensuring that therapy remains accessible to a broader range of clients.
But you can still use your insurance benefits!
The Seattle Counseling Center issues superbills, an itemized receipt provided by a healthcare provider that outlines the services rendered during a therapy session. It includes important details like:
Provider’s Information: Name, credentials, and contact information of the therapist.
Client’s Information: Name and sometimes additional identifying details.
Dates of Service: The specific dates on which services were provided.
Procedure Codes: Codes that correspond to the specific services rendered (often using CPT codes).
Diagnosis Codes: ICD codes that represent the diagnosed conditions addressed during the sessions.
Total Amount Charged: The total fee for the services provided.
How Clients Can Use Superbills
Submitting to Insurance: Clients can submit a superbill to their insurance company for reimbursement. Since some insurance plans offer out-of-network benefits, clients may receive partial reimbursement for therapy costs. It’s essential to check with your insurance provider to understand your specific out-of-network coverage, specifically asking whether or not psychotherapy is covered (billing codes 90837), what your deductible is, and whether or not they offer coverage for associate level therapists.
Tracking Expenses: Superbills serve as a detailed record of therapy sessions and associated costs, which can be helpful for budgeting and financial planning. Keeping these documents organized can assist clients in tracking their spending on mental health care.
Tax Deductions: In some cases, clients may be able to use the costs of therapy as a deductible medical expense on their taxes. Keeping superbills handy can provide the necessary documentation if you decide to claim these expenses.
Encouraging Accountability: By reviewing superbills, clients can reflect on their therapy journey, including the frequency of sessions and types of treatment received. This can foster a greater sense of commitment to the therapeutic process.
Communicating with Insurance: If there are any issues with reimbursement, having a superbill allows clients to provide detailed documentation to their insurance company, making it easier to resolve disputes or clarify coverage.
Tips for Using Superbills Effectively
Requesting a Superbill: When you finish a session, simply ask your therapist for a superbill. Most providers are familiar with the process and can generate one for you.
Understanding Your Insurance Policy: Before submitting a superbill, review your insurance policy to understand your out-of-network benefits, including any deductibles or limits on reimbursement.
Keeping Copies: Always keep a copy of the superbill for your records before submitting it to your insurance. This ensures you have a reference if needed later.
Tracking Submissions: Keep a log of when and where you submitted your superbill for reimbursement, along with any correspondence with your insurance company. This can help you stay organized and follow up as needed.
If you have questions about our practice or how to approach therapy without insurance, feel free to reach out. We’re here to support you on your journey to healing.