insurance

currently:

As of now, I accept private-pay and I am only paneled with First Choice Health Network and Kaiser Washington PPO plans. This means that unfortunately out of network for Kaiser HMO plans.

out-of-network

If your insurance plan includes any out-of-network [OON] benefits, many insurance providers will allow you to submit a superbill that summarizes your therapy services. Submitting a superbill will usually count towards your out-of-network deductible (assuming you have OON benefits). It is your duty to contact your insurance provide to find out if they will accept a superbill. Once you have hit your out-of-network deductible you will likely get reimbursed for all or most of my fee. Since insurance is confusing, we wanted to walk you through the process of using out-of-network benefits.

Abstract shape with rainbow colors, representing the values of Uniquely You Therapy Collective as a practice that specializes in working with LGBTQIA+, transgender, and queer adults.

how to understand (and use) out-of-network [OON] benefits:

Step 1: Check your out-of-network [OON] benefits.

There is no “one size fits all” guide on how to check your OON benefits. Here are three important terms to know that will make it easier to understand your insurance benefits.

  • Deductible: means that your insurance requires you to pay a certain amount out of pocket before your benefits will kick in. This amount varies for every insurance plan. Any time you pay for a health service prior to meeting your deductible, that amount will count towards meeting your deductible.

  • Co-Pay: refers to a fixed out-of pocket cost you pay for any number of services. For example, your insurance may have a $15 co-pay that applies any time you visit your primary care provider.

  • C0-Insurance: a payment similar to a copay, except that coinsurance is usually a percentage of the bill that you pay for out of pocket. For example, your insurance plan may have a 10% co-insurance any time you visit the emergency department. So if you received a bill for $400, you would be responsible for paying $40 out of pocket.

Here are the two most common ways to check your OON benefits:

  • When you sign up for a new insurance plan, or begin a new policy year with the insurance you already have, you will receive a thick, user-manual-type booklet sent to you by your insurance, often titled “Summary of Benefits”. In the Summary of Benefits there may or may not be a section about "Out of Network Benefits", which may include a subsection title along the lines of “Mental or Behavioral Health”. For most insurance companies, mental health services, such as therapy, are categorized into their own classification of benefits (please be aware that your insurance may work with a third party to handle their mental and behavioral health coverages).

    Once you find the section regarding Out of Network Benefits, begin scanning for any mention of mental or behavioral health benefits. If your Summary of Benefits contains this information, be on the lookout for the terms “Co-pay”, “Coinsurance” and “Deductible”.

  • If you did not receive a Summary of Benefits from your insurance, or can’t find anything about Out of Network Benefits or mental or behavioral health benefits in your Summary of Benefits, you can call your insurance directly to get this information. Call the member services number on the back of your insurance card (the number Is also likely online) and ask the following questions about your benefits:

    -Does my plan include OON mental health benefits?

    -What is my OON deductible for outpatient mental health?

    -What is my OON coinsurance or co-pay for outpatient mental health?

    -Do I need a referral from an in-network provider to see someone out of network?

    -Does my normal plan deductible apply to my mental health benefits? If it doesn’t, what is the deductible for my mental health benefits?

    -How much of my deductible (or mental health deductible) has been met so far this policy year?

    -How do I submit claim forms for reimbursement? (This is relevant, we promise!)

    To be transparent, we recommend calling your insurance and asking these questions even if you received a Summary of Benefits booklet, and were able to track down all of the terms, as speaking with an insurance representative allows you to ask as many questions as necessary to feel fully informed.

Step 2: How paying for therapy with OON benefits works:

Because out-of-network benefits are a bit different in coverage than in-network benefits, paying an out-of-network provider is a bit different as well. Whenever you meet with a provider that is out-of-network, whether they are a mental health provider or not, you will need to create and submit a claim to your insurance (rather than one being processed and approved on the spot).

Due to a claim being needed for out-of-network benefits, there are two things to know about how you pay your out-of-network therapist:

  • You will pay the full cost of your session up front.

  • You will receive appropriate reimbursement from your insurance once the claim has been processed and approved.

  • If your therapist charges $200 per session, and your coinsurance is 25%, or your co-pay is $50, you're responsible for paying $50. But the final total spent out-of-pocket for a session comes in the form of reimbursement from your insurance once the claim has been processed and approved. This means you'll pay $200 upfront and your insurance will send you a check for $150. Again, please remember that until your deductible is met, every service you pay for will be out-of-pocket with no reimbursement.

  • If you haven’t already, we recommend you call your insurance and ask them some questions (see step 1 under “call insurance directly”). They can explain how to file claims online through their web portal.

    Your therapist can provide a document called a “Superbill” at the end of each month that you'd submit to your insurance through their claims web portal. The superbill will include how many sessions you had during the month, the total fees from these sessions, and a diagnosis code.

    Due to the way insurance processes claims, every superbill created by a mental health professional must include a diagnosis code. You and your therapist will decide on which diagnosis(es) you are comfortable with including on the documents submitted to insurance.

Step 3: Receiving OON reimbursement

As we covered above in step 2, you will need to pay the session rate of your therapist up front at the time of your session. Then you submit a claim using a superbill (created by your therapist) and upload any other documentation that your insurance may require. Once that claim is processed and approved by your insurance, you will receive appropriate reimbursement check(s) for each session noted in the superbill and your claim (i.e the overall cost you paid up front minus the co-pay or coinsurance required for each session = your reimbursement check(s) amount). Please note that you may have an OON deductible that has to be met before insurance will begin to reimburse you.

If you are in crisis, please call 1-800-273-8255 [National Suicide Prevention Lifeline] or 1-877-565-8860 [Trans Lifeline]

or text “OSTEM” to 1-3-3-662-8209 [LGBTQ+ Crisis Text Line] or “HELLO” to 741741 [Crisis Text Line].