Deciding to accept out-of-network insurance coverage can open new opportunities for mental health practitioners, allowing them to serve a broader client base and enhance their practice’s financial health.

This involves understanding two billing methods: using a superbill and offering courtesy billing. By leveraging these methods and understanding billing and reimbursement practices, therapists can create a successful, financially sound practice that reaches a wider clientele.

Leveraging Out-of-Network Insurance Coverage

For mental health therapists, the decision to accept out-of-net- work insurance coverage can open up new opportunities. While it comes with different challenges compared to being in-network, leveraging out-of-network insurance coverage can be a strategic move to serve a broader client base and enhance the financial health of your practice.

Below, we’ll explore how mental health therapists can effectively utilize out- of-network insurance coverage.

The Benefits of Accepting Out-of-Network Insurance

For mental health therapists, the decision to accept out-of-network insurance coverage can open up new opportunities. While it comes with different challenges compared to being in-network, leveraging out-of-network insurance coverage can be a strategic move to serve a broader client base and enhance the financial health of your practice.

Expanded Client Base: Accepting out-of-network insurance allows you to work with clients who have insurance plans that you are not in-network with.

More Pay Per Client: Working with an out-of-network client means that you can charge your self-pay rate to the client, and the client will pay the full fee up front. If the client has out-of-network benefits, then their insurance can reimburse them a percentage of the self-pay rate.

Client Flexibility: Clients may appreciate the option to see a therapist of their choice, even if you are out-of-network, and are willing to pay the difference.

Understanding Out-of-Network Benefits

Treatment Guidelines: Before accepting a new client, verify their out-of-network benefits. This includes understanding their deductible, co-payment, and maximum allowable amount.

Claim Submission: Educate your clients about the process of submitting claims to their insurance company. Ensure they keep records of sessions and receipts for reimbursement.

Billing and Reimbursement

Superbills: Provide clients with superbills, which are detailed invoices that they can submit to their insurance companies for reimbursement.

Billing Transparency: Clearly outline your fees and billing practices to clients from the beginning, ensuring they understand the financial aspect of out-of-net- work therapy.

W-9 Form: Insurance companies will want a W-9 form from you, even if you are an OON provider.

Effective Communication

Open Dialogue: Maintain transparent and open communication with your clients regarding their insurance coverage and financial responsibilities.

Educate Clients: Help clients understand how out-of-network coverage works and the steps they need to take to seek reimbursement.

Documentation: Accurate and thorough record-keeping is crucial. Ensure that your session notes are comprehensive to support claims.

  • Helpful Tip: Laissez-faire about notes? Don’t be. If you are audited, the insurance company will clawback from the client if your records do not meet medical necessity.

Timely Filing: Familiarize yourself with the insurance company’s filing deadlines to ensure claims are submitted promptly.

Good Faith Estimate: This is a provision of the No Surprises Act where a provider must give clients an estimate of how much they will be charged for the therapy sessions they will be receiving. As of January 1, 2022, if you are a state-licensed or certified health care provider, you are required to give a Good Faith Estimate to every new and continuing client who is either uninsured or is not planning to submit a claim to their insurance for the sessions they have with you.

Strategies to Attract Out-of-Network Clients

Marketing: Promote your out-of- network services through your website, social media, and therapist directories to attract clients seeking specialized care.

Specializations: Highlight your expertise and unique therapeutic approaches to appeal to clients willing to
invest in out-of-network services.

Provide VOB Insights: Using a tool like Owl Practice Suite’s Verification of Benefits tool on your website can allow clients to look up their benefits coverage prior to booking an appointment. Therapists with a tool like this on their website see a 50% increase in their first appointments booked.

Managing Client Expectations

Discuss Expectations: Clearly communicate to clients that while you are out-of-network, you offer
specialized and high-quality services that may be worth the additional investment.

Sliding Scale: Consider offering a sliding scale or payment plans for clients who may struggle to pay your full fee.

Summary

Leveraging out-of-network insurance coverage can be a valuable strategy for mental health therapists. By understanding the benefits, effectively communicating with clients, and navigating the administrative aspects of billing, you can create a successful practice that reaches a wider clientele.

In doing so, you not only offer your expertise to those who need it but also maintain a thriving and financially sound mental health therapy practice.