When We Are Not In-Network With Your Insurance

When we are out of network

There are times when families need mental health care, but they find providers are not in network with their insurance.  Examples of insurance that we are NOT in network with include: United Behavioral Health, TriCare, Coventry, Medicare/Medicaid, and Aetna.  If you have Medicare/Medicaid as your primary insurance, and another insurance company as your secondary insurance, by law, we cannot submit claims for you.  You will be responsible for your coverage.

In these cases, your insurance may reimburse you for a percentage of fees by our office as out-of-network providers. If you decide to go this route, we will provide you with a statement suitable for submitting to your insurance company so that you may file claims on your own, with your insurance reimbursing you directly. Many patients are successful in seeking reimbursement for at least a portion of their assessment and therapy fees.  However, please remember that reimbursement is considered a matter between you and your insurance company. Always check with your insurance company directly for questions about your coverage and out-of-network benefits.

When your insurance does not cover mental health or when your insurance does not cover out of network benefits

There are also times when insurance policies do not cover mental health benefits.  If this is the case with your insurance, or your insurance does not cover out of network psychological services, then you are likely eligible to deduct the cost of services on your tax return as a health-related expense (please consult your accountant or tax return advisor for specific guidelines and information). You can also use money from a health savings account or flex account to pay for services.  We are glad to work with you in terms of receipts or statements that you would need for your accountant or year-end planning.

Determining your insurance coverage for mental health services:

To determine your out of network mental health coverage, the first thing you should do is check with your insurance by calling the number on the back of your card listed for mental health. Find the answers to the following questions:

  • Ask if you have “out-of-network” benefits?
  • Is there a deductible that must be met first, and how much is your deductible?
  • What is the coverage amount for the assessment and therapy session? Usually the insurance company reimburses a percentage of what it has deemed “usual and customary.”
  • How many therapy sessions does my plan cover?

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