Why Using Out-of-Network benefits for Therapy is the Best Choice for Clients
You deserve the power to choose YOUR mental health care
Seeing an out-of-network provider for therapy offers clients numerous benefits that make it the preferred choice for mental health care.
Clients have greater control over their therapy experience and can prioritize their specific needs and goals while receiving reimbursement for fees from their insurance company.
Reasons Why Clients Choose to see an out-of-network therapist
Benefits of Going Out-of-Network for Therapy
At Keystone Therapy Group, we understand the importance of privacy and confidentiality in therapy. That’s why we offer the option to go out-of-network for our services, providing our clients with a safe and trusting space to address their mental health needs. You can trust us to prioritize your privacy and provide a supportive environment for healing and growth during therapy sessions.
No Limit on Sessions
Out-of-network therapy allows clients to attend as many sessions as they need, without any restrictions or limits on the number of sessions that will be allowed as set by insurance companies.
No Long Wait Times
When choosing to see a therapist out-of-network, clients have the advantage of being able to see a therapist of their choice without worrying about long wait times for in-network therapists.
Personalized Care
Out-of-network therapy at Keystone allows for completely personalized care, tailored specifically to each client’s individual needs, without the limitations insurance companies put on your care.
Flexible Therapy Options
By choosing to go out-of-network, clients have more flexibility in their therapy options, with the ability to choose virtual or in-person sessions without having to adhere to insurance guidelines.
No Delay for Insurance Approval
Most out-of-network benefits don’t require pre-authorizations that some insurance plans require prior to beginning services. Available this week? As long as we have an opening, you can start ASAP!
No Diagnosis Required
When choosing to see an out-of-network provider, you are choosing to focus on your therapy experience and growth, not on a diagnosis that insurance requires for service.
Complete Confidentiality
When attending therapy out-of-network, your progress notes remain completely confidential. No risk for your insurance company to require that we send in your diagnosis, intake, notes, or treatment plan to validate “medical necessity” for them to cover your in-network sessions.
Higher Quality Care
Staying out-of-network allows your therapist to prioritize quality and individualized care for our patients. Without the limitations and restrictions of insurance, we have the flexibility to focus on the latest and most effective treatments, get to know our patients, and continually invest in our education and specialization.
How We Support Our Clients With Using Their Out-of-Network Benefits
At Keystone Therapy Group, we believe everyone deserves access to quality mental health support and are committed to finding a solution that works for you.
We Accept HSA/FSA Funds
At Keystone Therapy Group, we strive to make mental health services accessible for all. That’s why we gladly accept HSA/FSA funds as payment from our clients. This offers a flexible and convenient option for those looking to prioritize their well-being without financial strain.
We Provide Courtesy Billing
At Keystone Therapy Group, we understand the financial burden that therapy can sometimes place on individuals. That’s why we offer courtesy billing for our clients seeking out-of-network reimbursement, making it easier for them to receive the support they need.
We Offer Multiple Rates for Services
At Keystone Therapy Group, we understand that everyone’s financial situation is different. To support our out-of-network clients, we offer different rates for our therapists based on their level of experience. This allows us to cater to a range of budgets without compromising on the quality of our care.
We Provide Superbills
At Keystone Therapy Group, we believe everyone should have access to quality mental health care. That’s why we offer superbills to our clients seeking out-of-network reimbursement, so they can submit the claims directly to their insurance company.
Understanding Your Out-of-Network Benefits
We hear you asking:
“What are out-of-network benefits?”
Out-of-network benefits refer to services provided by healthcare providers that are not within an insurance’s designated network of preferred providers. Payments are made by clients directly to the provider at the time of services at our out-of-pocket rate.
Out-of-network benefits provide partial reimbursement of healthcare costs through the individual’s health insurance plan, typically between 50%-80% of the out-of-pocket cost. Often, the difference in cost with reimbursement is equivalent to a copay clients would pay seeing an in-network provider.
Understanding your benefits:
“Do I have out-of-network benefits?”
Most insurance plans do include out-of-network benefits. To determine your out-of-network benefits, please pull up this webpage and call the member services phone number on the back of your insurance card.
Ask the following questions:
- Do I have out-of-network benefits for psychotherapy / mental health therapy?
- Do I have an out-of-network deductible? How much have I reached? When does the deductible reset (typically January 1st)?
- What percentage of the cost is reimbursed for the following CPT codes:
- 90791 (intake/initial assessment)
- 90837 (individual psychotherapy, 53 min)
- 90834 (individual psychotherapy, 45 min)
- 90847 (couples/family therapy)
- 90853 (group therapy)
- Do I have coverage for therapy via telehealth/teletherapy (synchronous audio and video), with the modifier code -95?
- Is there a limit on the number of sessions allowed?
- Do I need a pre-authorization before beginning these out-of-network services?
- Can claims be submitted electronically?
- For Courtesy Claims: What Payer ID should my therapist submit courtesy claims to (5 digit code)?
- For Superbills: Where should I submit my superbills? Electronically or via mail?
- How long does it take to process the claims? How will I receive reimbursement?
What Information Your Insurance may require:
“What information will they request to confirm benefit coverage?”
Practice/Provider Information that may be requested:
Practice billing zip code: 22015
Provider Licenses:
– Kim Rippy, Virginia LPC
– Kaitlyn Steel, Virginia LMFT, New York LMFT
– Brianna Folkl, Virginia LPC
– Rhiannon Vergundia, Virginia LPC
– Essie Bent, Virginia LPC-R (licensed resident billed under supervision of Kim Rippy, Virginia LPC)
“What medical information does insurance require to reimburse for out-of-network benefits?”
To receive out-of-network insurance benefits, a mental health diagnosis, like anxiety or depression, must be met and will become part of your medical record. You can request a superbill with your name, provider details, service details, and CPT code for insurance reimbursement.
If you have questions, please don’t hesitate to discuss concerns with your therapist or contact us.
Ready to find yourself?
Ready to take the next step? Let’s bring your vision to life! Explore our services and get in touch today to schedule your free consultation with one of our therapists to learn how we can help you. Together, we’ll make it happen!
how do i get reimbursed?
“How can I get help with out-of-network reimbursement?”
At Keystone Therapy Group, we know the stress and bureaucracy that comes with insurance claims. That’s why we are currently offering courtesy claims to take the burden off of our clients. Let us handle the paperwork for you – we’ll submit the claims and you receive the reimbursement – so you can focus on your journey to healing.
If you would like to receive superbills and submit them yourself, there are couple different services that can help:
- Thrizer: Clients can submit superbills without therapist involvement for $2/claim. Thrizer offers end-to-end claims management with insurance, reimbursements via direct deposit, and clients can request an instant reimbursement to skip the insurance wait.
- Mentaya: Mentaya works directly with your therapist to submit claims on your behalf. Cost is 5% of the session fee per claim with a guarantee of successful reimbursement or your money back. Mentaya offers end-to-end claims management with insurance and handles resubmissions or corrections on rejected claims.
- Reimbursify: Clients can submit superbills without therapist involvement for $3.99/claim. Reimbursify offers support to walk clients through resubmitting or correcting any claim rejections, but does not manage it on behalf of the client.
“Why Don’t You Accept My Insurance?”
That’s a great question, and one we think about all the time. Unfortunately, being an in-network provider allows insurance to limit the number of sessions we can provide, get us caught up in billing issues, and pay us such a small percentage of the costs of therapy that it’s just not possible to maintain the high-quality care we pride ourselves on. Our priority is devoting our time and attention to our clients and ensuring we offer the best care possible, and not to endless insurance paperwork or billing issues.
Don’t allow insurance reimbursement to impede your access to exceptional therapy. We provide support in navigating out-of-network benefits, and offer flexible payment options to provide you with access to high-quality care. Don’t hesitate to contact us with any questions – we’re here to help!