Reasons Why Out-of-Network Services Could be a Better Choice for You

​If you are starting the journey in looking for a therapist/counselor here are some reasons why Out Of Network (ONN) services, as opposed to an in-network provider, may be better.

1. You’re looking for a therapist who is highly specialized and experienced
   
   Most in-network therapists are generalists.  While they are qualified to treat common conditions such as anxiety, depression, and challenges in navigating significant life events, they often lack specialized training, credentialing and experience with specific disorders.  Much like how many of us seek out a Family Practitioner or a Primary Care Physician for routine issues like the flu, we generally seek out or are referred to specialists for more serious and complicated conditions such as cardiac or neurological conditions.  
   
   Most out-of-network therapists are specialists who have niche practices.  If you have a specific condition or concern, it might be best to seek out and work with an out-of-network clinician or practice that has extensive training and experience in the area you are seeking help for.
   
   
2. You have a high deductible plan
   
   Many in-network insurance plans require a deductible to be met before the insurance covers their portion of the charges. A deductible is the amount you have to pay upfront before your insurance coverage kicks in. If you have a $5,000 deductible and you haven’t had any other medical expenses yet in the year, you are responsible for paying up to $5,000 in therapy session fees out-of-pocket before your standard co-pay applies. 
   
   Additionally, in-network therapists are limited by the insurance company’s contract with them in how they provide care to you. In-network therapists are restricted in the frequency and duration of care provided. So, if you are in crisis and feel that you need several sessions a week to stabilize and wish to remain in therapy for an extended period of time, an in-network therapist may tell you that they are only able to see you once weekly for a maximum of 8 – 10 sessions.  Out-of-network providers are not limited by insurance company guidelines on the frequency, modality, duration or orientation of care. You are free to decide what is best for your situation with your out-of-network therapist.
   
   
3. You have good out-of-network benefits
   
   If you have good out-of-network benefits, your insurance company may reimburse you as much as 90% of each session fee, depending on your specific plan’s coverage.  This means that in some situations, using your out-of-network benefits can actually be more affordable or comparable to your standard co-pay to see an in-network therapist.  I have seen situations where my patients must pay upfront to their in-network therapist for the first $5,000 of care. Once the $5,000 deductible is met, the patients are advised that they are not able to offer any further in-network sessions due to reaching a session max imposed by the insurance company.  So, in essence, the patient received no insurance benefit for the in-network care; they paid out of pocket and received no insurance benefit!! If the same patient had used their out-of-network benefit, they would have received 80% – 90% of the fees back!!
   
   
4. You want highly personalized services
   
   If a therapist isn’t constrained by providing services that the insurance company only authorizes, they are often able to spend more time and creativity crafting the perfect treatment plan for you. 
   
   
5. Out-of-network therapy opens doors for out-of-the-box treatment 
   
   Out-of-network therapists can offer longer, sessions, more frequent sessions or sessions that occur over a longer duration than compared with in-network insurance providers.  Out-of-network providers are also able to provide out-of-the-box solutions and care plans. 
   
   For example, if you are struggling with a substance use disorder (SUD), an out-of-network practice will be able to craft an individuated care plan of individual therapy, medications and toxicology testing that is highly privatized and discrete.  In-network providers may be locked into standard Intensive Outpatient (IOP) models that require participation in large groups, meeting 4 nights per week; 3-4 hours each session. In-network programs and providers often lack the flexibility in model and orientation of care as opposed to out-of-network. For example, many structured in-network substance abuse programs are full abstinence-based programs, whereas highly specialized out-of-network experts can offer moderated and controlled drinking approaches or harm reduction approaches.
   
   
6. You want to combine medication management with talk therapy 
   
   Some psychiatrists offer both psychotherapy and medication management, which allows for a more comprehensive understanding of your mental health needs before prescribing. 
   
   These services are often private pay, but they offer great convenience and highly coordinated care.
   
   
7. Privacy
   
   Privacy from your family and/or parents — If you are on your parent’s insurance plan and are uncomfortable with them knowing you are seeing a therapist, you might consider paying out-of-pocket.
   
   Privacy from your health insurance company — In order for your insurance to pay for therapy sessions, in-network therapists are required to provide the company detailed information regarding your sessions, including a diagnostic code and other highly private material. 
   
   If you don’t want your insurance company to have access to any information about your mental health, consider out-of-network and self-pay options.
   
   Privacy from your employer — In certain circumstances, your employer may be aware of how you are utilizing your health insurance benefit, especially if the company is self-insured.
   
   
8. You don’t want to wait to start therapy – Avoiding frustration and aggravation.
   
   In the local area, the majority of private therapists and practices do not participate in in-network insurance plans.  Those few therapists that do participate as in-network tend to be full and have long waiting lists. Out-of-network, private pay therapists tend to have more availability and greater flexibility in scheduling new clients.
   
   I routinely receive calls from prospective patients who have spent enormous amounts of time and energy seeking a therapist who takes their insurance.  Many describe that numerous in-network providers don’t return calls, are full and have waiting lists or don’t have the time availability that works. To further their frustration, they call the insurance company and request a list of local providers only to realize that the directory is a “ghost list” of closed practices and wrong numbers.
   
   
9. You found a great match!
   
   At the end of the day, your relationship with your therapist is one of the most important aspects of the healing process. 
   
   If you only consider in-network therapists, you might eliminate therapists who would be a really good fit for you and maybe help you feel better faster. 
   
   Choosing an in-network therapist who doesn’t make you feel comfortable or doesn’t specialize in the areas you’re struggling with solely because they’re in-network is a waste of money. Prioritize the personality fit and you’ll find a great match.

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Thom Kessler, LMFT, RAS
Licensed Psychotherapist
Registered Addiction Specialist
Certified EMDR Trauma therapy
Gottman Level III 

​PHONE: 415-454-8931
EMAIL:  [email protected]
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