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.
Navigating Administrative Challenges
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.
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