• Rachel Gabrielle

Playing the Insurance Game

Insurance can be a huge barrier in finding the right therapist. My previous post explained why many therapists won't take insurance, which makes it seem like there is a shortage of us. I didn't even mention the fact that insurance requirements dictate your treatment plan and diagnosis, which deserves its own post and is a disservice to the client.

Although you'd think having insurance means you have better access to care, that's not necessarily the case. Every therapist I know who takes insurance has a long waitlist. The insurance game is actually to create many barriers for both patient and provider so that they don't have to pay! On the provider end, there are many hoops to jump to get reimbursed (and it takes weeks and in some cases months). On the patient end, just finding the care is difficult. Wading through insurance directories that haven't been updated and sitting on waitlists for months/years only to see a burned out provider. How is that helping you?

There are ways to get better at playing the insurance game if you're willing to take on some upfront costs that will pay off for you in the end.

Going out of network and paying out of pocket for a therapist is a great way to meet your insurance deductible, and many people have plans with out of network benefits they are not taking advantage of. An out of network therapist can give you a detailed monthly bill that you submit to insurance yourself for reimbursement and/or applies to your deductible. In many cases, the client actually gets reimbursed at a higher rate than the therapist!

Alternatively, staying in network isn't always the best financial decision and here's why: If you have a $25 copay and are in therapy for a year, that's around $1300 of costs NOT going towards your deductible. Most deductibles I see are under $2,000 - so imagine you could actually meet that within a few months and then have access to even more providers and benefits that you are entitled to.

The first step towards taking advantage of your out of network (OON) benefits is calling member services and asking about what your OON are (in some cases you can easily find this information online). Next, you'll want to ask how you go about submitting your own claim. Some insurance companies make this very easy to do online and others are going to require something archaic like a fax. Lastly, you'll want to ask your treatment provider for something called a "superbill" each month that will have all the information the insurance company wants for reimbursement. That's it! Happy therapist hunting!

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