Why should access to care be at the cost of therapists? A lot of therapists dream of running a cash pay only practice, yet are afraid that being strictly private pay may close the door to therapy for people who may not be able to afford it. So, how can therapists feel empowered to have private pay clients and remain accessible? One solution that is underutilized is: out-of-network benefits.

Here are three steps therapists can take to:

  1. Help clients remain clients when switching from insurance to private pay
  2. Or help incoming clients leverage their benefits to access your care 

Step 1: Educate Your Clients on Out-of-Network Benefits

To start using out-of-network benefits to attract more clients as a therapist, it’s important to educate yourself and your clients on this option. This includes explaining to your clients that they can use their insurance to cover the cost of therapy sessions with you, even if you are not in-network with their insurance company. Many people are unaware that they can get reimbursed up to 80% for out-of-network therapy.

It can also be helpful to provide clients with a basic understanding of insurance jargon and how out-of-network benefits work. You can use the following language to explain it:

As an out-of-network provider, I do not accept insurance directly. However, many PPO, POS, and HDHP insurance plans offer out-of-network benefits that help clients get reimbursed for therapy. To use these benefits, you can first check your deductible, which is the amount you need to pay out of pocket for health services before your insurance benefits kick in. Once the deductible is met, you can start getting reimbursed anywhere from 40-80% for my services, depending on your plan’s benefits. Finally, to claim reimbursement, you will need to submit out-of-network claims to your insurance company.

Step 2: Make It Easy For Clients To Find Out What Those Benefits Are

There are several ways to help clients understand their out-of-network benefits. Here are some options:

  1. Providing a script for clients to call their insurance company to find out their benefits. This can be convenient because it removes you from the process, but clients are unlikely to follow through, are frequently put on hold for a long time, and may struggle to understand the insurance jargon associated with their benefits.
  1. Hiring a part-time biller to assist with insurance questions. A biller can call insurance companies on behalf of clients and provide detailed information about their benefits. However, billers can be expensive – so you need to weigh the benefits of having a biller assist with insurance questions against the cost of hiring one.
  1. Using instant benefits verification tools, such as widgets provided by companies like Zaya Health. These tools can be added to your website and allow clients to easily enter their insurance information and find out their benefits. This option may have a small cost associated with it, but removes you from the process and is convenient for both you and your clients.

Step 3: Help Your Clients Figure Out How To Use Their Benefits

Although educating your clients on their OON coverage is extremely valuable, it’s not enough.  They also need to know how to access and use these benefits. 

Here are some ways you can help them use their benefits:

  1. Submitting claims for your clients. This can help you maintain your full fee for your services, but it can be a time-consuming process. You will need to manage the claim submission process and communicate with insurance companies to ensure that your clients receive the reimbursement they are entitled to. 
  1. Creating a superbill for your clients. A superbill is a document that outlines the services that were provided, along with the relevant codes and charges. If you use an electronic health record (EHR) system that generates superbills for you, this can require little work on your end.

However, your clients may not understand how to submit superbills, or forget to submit them before the timely filing limit. They also sometimes run into issues and claim denials when trying to submit their superbills to their insurance, in which case they may need your help.

  1. Using tools like Zaya Health that automatically submit out of network claims. These tools can help streamline the process of submitting out-of-network claims without requiring any additional work for you or your clients. This convenience can come at an additional cost for clients, but can save you time and effort and allow you to maintain your full fee. Claims are also checked for accuracy and submitted digitally, which reduces the turnaround time and increases the likelihood of successful reimbursement.

Helping Clients Understand Insurance Helps Them Access Your Care

While you may have spent a significant amount of time learning about the brain, behavior, and how to treat mental health conditions, most therapists don’t learn private practice skills in grad school. It makes sense if insurance feels complex and confusing. 

But for private pay therapists, helping clients understand their insurance options is an important way to make therapy more accessible to them. You can empower them to take full advantage of the insurance benefits (that they already pay for) and convert them into private pay clients. 

Guest Author: Maria Lulo

Maria is the lead therapist advocate at Zaya Health, spearheading initiatives to improve the therapist experience. She brings a wealth of knowledge and passion to her role, as an aspiring clinical psychologist with a degree in Psychology from Duke University.