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An in-network provider accepts your insurance, and you likely will pay only a copay. If a therapist does not take your insurance, they are considered out-of-network. Make sure to check with your provider to confirm if you have out of network benefits.
Your therapist may be able to do this for you, but it is always a good idea to verify yourself. You can call your insurance company and ask them if you have "out-of-network outpatient mental health benefits”. If so, make sure to follow up with these questions:
This is the amount you need to pay before your insurance starts to cover your healthcare costs.
A copay is what you pay to an in-network provider. This is part of the therapist’s agreed upon session rate with your insurance. You pay the copay and your insurance pays the remaining to your therapist.
Coinsurance is a percentage of the session rate that you will not get back for therapy. This is usually when you see a therapist that is out-of-network (does not take your insurance). You may have to pay a therapist's entire session rate, but will be reimbursed from your insurance If applicable.
This is the maximum amount of money an insurance company will allow for a therapy session. This may be lower than your therapist's session rate. Insurance plans will have different UCRs.
Always make sure you check your out-of-network benefits before starting therapy so that you have an idea of what you are responsible to pay at the time of session.
Many therapists will provide you with a document called a “superbill” that you can provide to your insurance company to receive reimbursement. Some therapists will even submit necessary paperwork for you.
This depends on how often you or your therapist sends in necessary paperwork to your insurance company. On average it will take 4-6 weeks to be reimbursed. Remember: you will not be reimbursed until your deductible is met.
Everybody's situation is different. Make sure to check your benefits so there are no surprise costs and if confused ask your therapist to explain.
