What Out-of-Network Care Costs You

Most people who call us have already had a version of the same conversation with themselves. They have found a clinician they want to see. They have read the word out-of-network. And they have quietly assumed that means the number is going to be bad, so they put the call off for another month.

What out-of-network means

Elevate Your Mind does not bill insurance plans. We are an out-of-network practice, which means you pay the practice directly for your visit, and your insurance plan reimburses you afterward if your plan includes out-of-network benefits.

Clients receive a detailed superbill to submit for out-of-network reimbursement.

That is the whole mechanism. There is no hidden step.

What a superbill is

A superbill is an itemized receipt of your visit. It lists your provider, the date and type of service, and the codes your insurance company needs.

You send it to your plan. If your plan has out-of-network benefits, they may reimburse part of the cost. Your plan decides how much.

It is the same document a physical therapist or a specialist outside your network would give you. Nothing about it is unusual, and you do not need to prepare anything in advance to receive one.

The three questions that tell you your real number

Before your first visit, call the member services number on the back of your insurance card and ask these three things. Ten minutes on the phone will replace a month of guessing.

One. Do I have out-of-network outpatient mental health benefits?

Some plans do. Some do not. This single answer determines everything that follows.

Two. What is my out-of-network deductible, and how much of it have I met this year?

Reimbursement usually begins only after this deductible is met. If you are late in the plan year and have already met it, your reimbursement may start immediately.

Three. Once the deductible is met, what percentage of the allowed amount do you reimburse, and is there a visit limit?

Plans commonly reimburse a percentage of what they consider an allowed amount rather than a percentage of what you paid. Asking for both numbers gives you an accurate estimate instead of an optimistic one.

Write the answers down. Ask for a reference number for the call.

Why some practices work this way

Insurance contracts come with requirements about session length, documentation, frequency, and which treatments are approved for which diagnoses. Those requirements shape care whether or not they fit the person in the room.

Working outside those contracts means the length of a session, the pace of treatment, and the amount of time a clinician spends preparing for it are decided clinically. That is the tradeoff. You take on the billing step, and the care is built around you rather than around a contract.

Whether that tradeoff is right for you is a real question with a real answer in either direction, and it depends on your plan, your budget, and what you need.

You are also entitled to an estimate in writing

Every client has the right to a Good Faith Estimate of expected charges before their first visit. This is federal law, not a courtesy. If you want the number in writing before you commit to anything, ask for it, and we will send it.

Where to start

If you are not sure what your plan covers, call them first. If you would rather talk it through with a person, The Client Concierge can walk you through what to expect before you book anything.

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If you are in crisis, call or text 988, call 911, or go to your nearest emergency room. Elevate Your Mind is not an emergency service.