Understanding Out-of-Network Benefits and How Embracing Insight Makes It Easier
At Embracing Insight Mental Health Counseling, PLLC, we are an out-of-network provider, which means we do not directly contract with insurance companies. However, many insurance plans offer out-of-network benefits that allow you to be reimbursed for a portion of the cost of therapy, often after a deductible is met if one applies to your specific insurance plan. To help simplify this process for our clients, we use Thrizer, a billing platform that streamlines claims submissions and reduces your upfront costs.
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Out-of-network benefits allow you to see a therapist who is not directly contracted with your insurance provider while still receiving partial reimbursement for your sessions. Instead of paying only a copay like you would with an in-network provider, you pay the full session fee upfront and then submit a claim to your insurance company for reimbursement.
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Not all insurance plans offer out-of-network benefits. Typically, PPO (Preferred Provider Organization) and POS (Point of Service) plans are more likely to include them, whereas HMO (Health Maintenance Organization) and EPO (Exclusive Provider Organization) plans may not. It’s important to check with your insurance provider to determine whether your plan includes these benefits.
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To find out if you have out-of-network benefits, you can:
Call the customer service number on the back of your insurance card and ask about your out-of-network mental health benefits.
Ask your insurance provider about your deductible (the amount you need to pay out-of-pocket before reimbursement starts) and your reimbursement rate (the percentage of the session fee your insurance will cover once the deductible is met).
Use online member portals provided by your insurance company to review your benefits.
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Choosing an out-of-network provider gives you greater flexibility in finding the right therapist for your needs. Some benefits include:
Access to specialized care and your preferred provider that may not be available in-network.
More personalized treatment without the restrictions imposed by insurance networks.
Potential reimbursement that reduces overall costs after meeting your deductible.
Increased confidentiality and privacy, as fewer treatment details are shared with insurance companies compared to in-network services. At Embracing Insight Mental Health Counseling, all records are stored in a highly secure HIPAA compliant electronic medical records system and information will only be shared at the specific request of your insurance company, as compared to in-network therapists who are required to provide more detailed information session by session and extensive rationale as to the medical necessity of psychotherapy treatment.
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We understand that dealing with insurance claims can be complicated and stressful, which is why we use Thrizer, a platform that simplifies out-of-network billing. Here’s how it works:
Reduced upfront costs: Instead of paying the full session fee upfront, Thrizer allows you to pay only your estimated out-of-pocket cost after reimbursement once your deductible, if applicable, is met.
Automatic claim submission: Thrizer handles claim submissions directly with your insurance company, so you don’t have to worry about paperwork.
Faster reimbursements: By streamlining the claims process, Thrizer helps you receive your reimbursements quicker than if you submitted claims manually.
By using Thrizer, we make therapy more accessible and financially manageable, ensuring you can focus on your well-being without the extra stress of insurance paperwork.