NETWORK DEFICIENCY: “I Can’t Find a Therapist Who Takes My Insurance!”
Most people will want to maximize their health insurance benefits when seeking therapy. The best way to do that is to find a therapist who is an “In-Network Provider” with your insurance.
In-Network therapists are therapists who have signed a contract with an insurance company, agreeing to certain terms nd conditions including how much they will be paid for sessions.
For the client, this rate is generally lower than what most therapists charge “Out of Pocket” or “Out of Network.”
But what happens if you cannot find a therapist who is In-Network with your insurance company? What happens when everyone you call doesn’t have current openings OR isn’t specialized for what you need OR is too far away to reasonably drive on a weekly basis?
I don’t pretend to know all of the legalities, but insurance companies do have legal requirements for benefits and services provided to their card holders. If you can’t find a therapist who is In-Network, DON’T GIVE UP!!! Below are some steps you can take to obtain mental health services AND still use your health insurance benefits.
Using the list your insurance company provides of therapists who are in network, call all of them that are of a reasonable distance, specialty, etc. Keep track of who you have called and what the result was.
Contact your insurance company, let them know that you were unable to find anyone on their In-Network Provider list, and ask them specifically if they will pay an Out-of-Network Provider. Some insurance companies will have you complete a “Network Deficiency Form” which will then allow you to see an Out-of-Network provider, and be reimbursed as if they are In-Network. Be sure to get all of the details about who has to submit the claim (therapist or client), how much they will reimburse (will it be the therapist’s full rate?), and make sure any amount you do not get reimbursed for will still go toward your In-Network Deductible (if applicable).
Find an Out-of-Network therapist who DOES meet your needs. Not being limited to In-Network providers will widen the net of your search significantly.
Let your insurance company know when you have found an Out-of-Network therapist who meets your needs and confirm with them the details and next steps. They may want to arrange a Single Case Agreement (SCA) with that therapist, or have some other procedural requirements.
If you are not satisfied with the results of the above steps, and are not getting the answers you need from your insurer, you can contact your employer’s Human Resources Department if you have an employer sponsored plan, and ask for their advice. This is not a necessary step if you are uncomfortable discussing your mental health needs with your employer, but employers often want to know if the insurers they contract with and pay premiums to are not meeting their employers needs. And they may have channels to correct the situation.
Lastly, if you are still not satisfied, you can contact your stat'e’s Bureau of Insurance to ask them for advice. They know all the legal requirements of insurance companies in your state, and will help you to understand your policy as well as your rights .
