mental health counseling in new york

Why It Is Better To Use Your Mental Health Out-of-Network Benefits!

Looking for a therapist is a daunting process and often times the cost of therapy is our utmost priority. Therefore, staying in-network appears to make the most sense, but contrary to popular belief, out-of-network benefits are not more expensive than your in-network benefits.

If you’re beginning the process of finding a therapist, below are some reasons why looking for an out-of-network therapist as opposed to an in-network therapist may be better.

Quality of Care
Out-of-network therapists are not regulated by insurance. Therefore, they can offer more sessions and longer sessions if needed compared to in-network providers.

In addition, most out-of-network providers don’t have to fill their caseload and they see an average of 20 clients a week, allowing them to be available for an extra emergency session if needed; as well as clients can contact them between sessions by email or phone call if needed. Most in-network therapists have full caseloads of 40-plus clients and that limits the time they have to provide you with the care you need.

Looking For A Therapist That Specializes in and Has Experience With Your Major Mental Health Concerns
Most in-network providers are general therapists treating general mental health concerns such as anxiety, depression, etc. They do not specialize in specific mental health concerns like OCD, eating disorders, trauma, etc. as they don’t receive the proper training and ongoing consultation needed to treat those mental health disorders. Similarly, as you’d see your general practitioner for day-to-day sickness and pain, we often seek out or are referred to specialists for more difficult conditions and health concerns.

Most out-of-network therapists have specialties and niches. Therefore, if you have specific mental health concerns it is best to seek out an out-of-network therapist who has expertise in that area.

Finding A Therapist
Limiting yourself to in-network providers limits you to finding the right therapist for you. In addition, that therapist may not have availability for weeks or months and you can get stuck on a waiting list. Oftentimes, people’s mental health worsens while being stuck on a waiting list. Sticking with out-of-network providers opens up more options for you and gets you quality care quicker.

In addition, it becomes more difficult to find the right therapist for you. As a result, you jump around from therapist to therapist, starting over, and eventually using up your “allowed” amount of sessions insurance will cover and you end up going out-of-network in the long run.

Insurance creates a lot of roadblocks to mental health care and makes quality care less accessible. Your mental health is extremely important and is worth the investment! You wouldn’t pick a general practitioner to do brain surgery, you’d pay the neurosurgeon to ensure proper treatment and care.

You Won’t Be Forced To Change Therapists
If your insurance changes, you won’t have to change therapists as you’re already using an out-of-network therapist. Meaning you won’t have to start over, rebuild trust, or get comfortable with someone new.

Cost of Therapy
Often out-of-network benefits are affordable or even more affordable than going in-network.

In-Network Is NOT Cheaper
In-network benefits require you to pay a copay for each session which can sometimes be quite high and cost more money than using your out-of-network benefits. You may also have a high in-network deductible, meaning you’re still paying out of pocket for months before your insurance kicks in. Unfortunately, once the in-network deductible is met, the insurance company reserves the right to deny any further in-network sessions they do not deem to be “medically necessary.” Therefore you’d be responsible for the full session fee with no option for reimbursement. With out-of-network benefits, once you meet the deductible, the insurance cannot deny treatment and you can receive up to 90% reimbursement for the session fee.

Insurance Companies Can Limit The Number of Sessions For In-Network Clients
This puts you at risk of ending therapy before you’re ready or being forced to pay out-of-pocket for more sessions with no option for being reimbursed. The healing process is different for everyone and can take longer than the allowable number of sessions insurance will cover. Insurance companies cannot limit the number of sessions provided for out-of-network benefits.

In-network therapists are required to provide clinical documentation in order to deem the services “medically necessary,” compared to out-of-network providers who are not contracted with insurance companies and do not have to provide clinical documentation, therefore, protecting your privacy.

Assigning A Diagnosis
In order to submit claims in-network, the therapist must provide a diagnosis. This diagnosis can follow you later in life in court cases as your insurance company will be required to provide the court with your treatment information or prevent you from obtaining life insurance.