You’re looking for a therapist in #SanDiego that takes your insurance and you keep hearing these two different terms “in-network” and “out-of-network.” What do they mean? 

I’m here to break this down and help you better understand how you can utilize your insurance for your therapy.

Before I break down what each term means, let me provide a brief explanation of the difference between an HMO and a PPO.

HMO vs. PPO

Health Management Organizations (HMOs) offer a network of providers and hospitals that are all under the same umbrella and have a predictable cost for specific services (co-pays) such as primary care, speciality visits or labs and medications. 

Preferred Provider Organizations (PPOs) offer more flexibility in the type of provider that you can choose, hence the title “preferred provider.” With a PPO plan, you have the choice of being seen by an in-network provider or expanding your options further by going out-of-network and seeking reimbursement for your out-of-pocket costs.

In-Network Providers

An in-network provider is a therapist who has specifically contracted with your insurance company. Insurance companies negotiate an approved rate that they pay directly to the therapist and you only have to pay your copay, co-insurance and any deductible (if applicable) before your insurance benefits kick in. If you have an HMO, you need to be seen by an in-network provider.

The best way to find out which therapists are in-network is by calling your insurance company and asking for a list of network providers. You can do this by calling the number on your insurance card. Click here to learn more about how to find a therapist in San Diego that matches your specific needs.

Out-of-Network Providers

An out-of-network (ONN) provider is a therapist who has chosen not to participate with any particular insurance company.

ONN providers are able to provide you with a specialized receipt (called a “super bill”) that you can submit directly to your insurance for partial reimbursement of services depending on your plan coverage (ie. less any copay, coinsurance and deductible).

Following are some questions  you can ask of your insurance provider to check your coverage:

  • Do I have mental health insurance benefits?
  • What is my deductible and has it been met?
  • How many sessions per year does my health insurance cover?
  • What is the coverage amount per therapy session?
  • Is approval required from my primary care physician?

Additionally,  psychotherapy is a reimbursable expense under many Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA), please check your plan for more details.

I hope this helps you better understand how you can apply your insurance benefits for therapy and find the right therapist in Chula Vista or San Diego, CA. 

If you’re still feeling stuck or confused about the process, feel free to call me at (619) 494-0754 for a free, 15-minute phone consultation. I’d be happy to learn more about what’s going on with you and see how I can help point you in the right direction.

 

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