A Therapist’s Guide To Out-of-Network Benefits

Published: February 14, 2024 by Zencare Team

Health insurance is a great enabler of well-being and yet — could be called the biggest cause of stress for most therapists. Many people understand that using health insurance to cover therapy sessions is a cost effective option, yet it’s likely that most don’t know exactly how to use these benefits — and even therapists struggle to understand how to implement effective practice processes when it comes to insurance.

With more therapists turning away from traditional insurance panel membership and instead offering a self-pay option, it’s a great time to understand out-of-network benefits and how they might apply to your practice so you can help clients access affordable therapy.

Why out-of-network benefits can be confusing for clients

Unless someone works in the health insurance industry, or tangentially, the general population often struggles to understand what out-of-network benefits are and how they can be used. While the term “in-network benefits” may be rather intuitive, out-of-network benefits include complicated and confusing concepts like deductibles, reimbursement rates, and coinsurance.

Why aren’t out-of-network benefits more straightforward for the consumer? Most health insurance companies prefer for their plan holders to rely on in-network providers. By making out-of-network services less accessible, they encourage their plan holders to pursue in-network providers. This means that information about out-of-network allowed amounts and reimbursement rates can be difficult to find, reducing someone’s confidence in using these benefits.

Clients may also avoid using out-of-network benefits because the process relies on their ability to pay upfront. While they are ultimately paying less for therapy when using their out-of-network benefits, they still need to be able to cover costs on hand and the administrative skills to request reimbursement. When multiple steps are involved in the administrative process, many clients may prefer to look for in-network providers. However, out-of-network therapy doesn’t have to be inaccessible — and there are steps that therapists can take to assuage the concern of clients.

Why it’s worth it to explain out-of-network benefits to clients

To help clients feel more comfortable using their out-of-network benefits, it’s worth explaining how these benefits work. If clients can put financial concerns to the side, therapy can become about their well-being.

Most companies will reimburse 50-70% of the session fee for out-of-network services, which could make therapy sessions with an out-of-network therapist budget friendly for most people. It might be helpful to do the math with your client, demonstrating that while they’re paying the whole session fee upfront, they’re getting a certain amount back after reimbursement.This exercise might help them feel more confident in their ability to make a decision about whether they can begin therapy and how often they’ll see you.

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How you can help your clients understand out-of-network benefits

Before the first session

Before the first session — and perhaps before you even hear from a prospective client — you can be upfront about costs by clearly displaying your session fees on your website or Zencare profile. You might also consider having educational resources on hand that cover different billing options, like super billing, or tips on how to file reimbursements.

All health insurance plans come with a Summary of Benefits document that lists out the details of both in-network and out-of-network services. If possible, you could go through this document with your client or prospective client, showing them the line item that relates to your services, and then taking them through the out-of-network rates.

Giving clients clear information about the process they’ll need to go through when using their out-of-network benefits means that they will know what to expect, and hopefully they can avoid any surprises. You might also encourage them to contact their insurance company to talk through their benefits and confirm coverage for your services before their first session.

To best help clients to understand their out-of-network benefits, you can share the checklist below with them to go through to ensure a smooth, stress-free process.

Download Your Free Out-of-Network Benefits Checklist

To reduce the administrative burden on your clients, Zencare offers therapists the tools they need to quickly verify benefits and to submit claim forms for their clients through the Private Pay Booster. Curious how this works? Check it out through an interactive walk-through to see if this is the right tool to support your practice and make health insurance benefits more accessible for your clients.

During therapy

Insurance benefits may come up in conversation during sessions, and talking about how a client is going to manage the reimbursement process can be an opportunity for you to show support for your client. Clients may also feel empowered when they feel well-informed about their insurance benefits. To support this achievement and to set expectations, you can help them understand that reimbursements take time and that it may take several weeks before their insurance company provides them with payment — however, that it’s worth going through the process because it means more affordable mental health services.

Zencare’s Private Pay Booster makes this process easier because it allows clients to file their claims directly through an app called Reimbursify. This can make the process less confusing and give your clients comfort knowing that their reimbursement is on its way.

After the first session

Checking in on a client’s reimbursement after the first session can be an effective way to ensure that the process is running smoothly. While some clients procrastinate on filing their claims, they might find that their therapy costs add up. To avoid this, it can be helpful to encourage your clients to submit their claims within the same week of their sessions.

When using Zencare’s Private Pay Booster, clients can submit their claims quickly and easily through Reimbursify’s app so they don’t have to go through their insurance company.

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