A note about insurance reimbursement for individuals who do not have BCBS: 

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Many people assume they need to choose only from providers listed in their insurance network, often because they have not been told about other options. One of the most important things to check is whether your plan includes out-of-network benefits.

 

For clients who have other insurance plans than BCBS, I am considered an out-of-network provider. I also work with clients who prefer not to use insurance at all. 

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Insurance companies usually encourage members to see in-network providers, and those visits may come with a copay. However, many plans now also have high deductibles, which means you may need to pay the full cost of care until that deductible is met, even with an in-network provider.

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If you do not have BCBS, it is worth contacting your insurance company or reviewing your benefits to see whether your plan includes out-of-network coverage. If it does, you may be able to submit claims for reimbursement and recover part of the cost of sessions. While your out-of-pocket cost may still be higher than a standard in-network copay, many clients find that the ability to work with the right provider is worth the difference.

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Because out-of-network benefits can be confusing, many people overlook them and spend unnecessary time trying to find an in-network therapist, without realizing they may have more flexibility than they thought.

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Examples

Scenario A
John has insurance through Prism. He sees an in-network therapist who charges $150 per session, and John pays a $40 copay for each visit. John’s total out-of-pocket cost after 20 sessions: $800

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Scenario B
John has insurance through Prism. He sees an in-network therapist who charges $150 per session, but his plan has a $3,000 in-network deductible. He must pay the full cost of care until that deductible is met, after which he pays a $40 copay.

John’s total out-of-pocket cost after 20 sessions: $3,000

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Scenario C
John has insurance through Prism. He sees an out-of-network therapist who charges $150 per session. John pays the therapist directly, then submits claims to his insurance company. His plan reimburses $100 per session, leaving him responsible for $50 each visit.

John’s total out-of-pocket cost after 20 sessions: $1,000