Using Out-of-Network Benefits For Therapy

This post will give you a better understanding of how to use your out-of-network insurance benefits to pay for some or all of the cost of therapy. 

Let’s run through an all too common scenario that individuals who are looking for counseling in North Carolina and Virginia are experiencing. 

1- You’ve acknowledged that your anxiety is no longer tolerable and that it’s impacting your life more than you’re comfortable with. 

2- You’ve asked your friends and the social media abyss for recommendations on therapists who treat anxiety and OCD and received a ton of input.

3- You’ve done your own research and narrowed down to 3-4 therapists that you might like to work with. 

4- You schedule an initial phone consultation and chat with the prospective therapist and begin to feel at ease, hopeful, and looking forward to starting therapy. 

5- You learn that this therapist, who seems to be a great fit for you (are we a good fit?), is not in-network with your insurance. 

6- You hear the words “insurance” and “out-of-network” and are immediately disappointed, overwhelmed, and confused.

7- You decide you don’t need therapy because it takes too much work to find a therapist and once you find one the insurance piece seems too complicated.

Does this sound familiar?

I have had these conversations both with prospective clients and as a client seeking a therapist. There have been times when I have continued on my search to find an in-network therapist and there have been times (like currently) when I am willing to navigate out of network insurance benefits or pay privately to work with a particular therapist.

I hope this post will help ease some of the insurance confusion and open up the possibility for you to work with whichever therapist you feel is the best fit for you even if they are an out-of-network therapist. Research shows that the quality of the therapeutic relationship has the most significant impact on therapy outcomes. 

Good fit therapist = greater likelihood of therapy success

So, if you discover that the therapist you wish to work with is out-of-network, you have a few options to explore.

First, you can check with your insurance plan to see if you have out-of-network benefits. 

Steps to check your out-of-network benefits:

1. Find your insurance card and call the number on the back of the card listed for member services. Some therapy practices will do this for you.
2. Once you get a representative on the phone ask  “Do I have out-of-network benefits for therapy services?” More specifically than “therapy services” you can say “outpatient mental health counseling,” specify virtual or in office as well. They will probably transfer you once or many times but hang in there. Go for a walk. Do some laundry. Do anything to distract you while you are on hold.
3. You may discover that you do not have out of network benefits or you may discover that you do. If you do, the rep will provide you with details of your out-of-network benefits. 
4. If out-of-network benefits are available to you, you and your therapist will discuss how your claims/payments will be handled.

Second, you can look into obtaining a single case agreement with your insurance to allow you to see the therapist of your choice. You have a right by law to receive effective evidence-based treatment even if there is no one in-network. For example, if you are seeking a therapist who treats anxiety and OCD who has training in evidence-based treatments for anxiety and OCD, like exposure and response prevention, you can submit a request for a single case agreement.

Steps to request a single case agreement:

1. Find your insurance card and call the number on the back of the card listed for member services. 
2. When you get a representative on the phone tell them, “I am seeking a single case agreement to cover an out of network therapist that I am seeing.” This might also be referred to as an “in-network exception.”
3. You will need to emphasize that the therapist provides an evidenced-based treatment modality for the issue that you are having.
4. Each insurance plan is different in how they proceed from here. They may ask you to provide detailed information on the therapist including their license number and tax ID as well as procedure codes. Your therapist can provide this information to you. Insurance might send a few forms for you and the therapist to complete and send back. Other carriers will request a phone consultation with the therapist. It just depends on your particular situation and plan. 
5. If a single case agreement is established, you and your therapist will discuss how your claims/payments will be submitted.

Finally, you might not want to get involved with any of the above insurance processes and choose to keep looking for an in-network therapist. Or you can decide that seeking therapy with a good fit therapist is a priority and make some financial adjustments to be able to afford to pay for therapy without using insurance. You can also talk to your therapist about the frequency of sessions and come up with a schedule that meets your therapy needs while also balancing your financial needs.

 Seeking therapy can be an overwhelming, tedious process in and of itself and I commend you for giving it some consideration. If you get stuck along the way of trying to start therapy, involve a friend or family member. It’s ok to take a break from searching but don’t let it turn into indefinite avoidance or procrastination. Your mental health matters and it is possible to feel better.

Hopefully this post lays out some options for you to work with a therapist who specializes in what you are needing help with regardless of their insurance status. 

Therapy Services Offered at Evercare Counseling

Evercare Counseling offers a range of mental health services to help provide you with more support. These services include anxiety therapy, ERP therapy, OCD treatment, therapy for women, and Christian counseling. Online therapy is provided throughout Virginia and North Carolina. You can find information on our counseling rates and how we work with insurance here. For more about us check out our FAQs and blog!