Benefits of Going Out of Network
Seeking a behavioral health provider for your child within your insurance network may seem to make sense from a financial standpoint at first glance. People already pay a lot for their insurance plans and would like to use those plans to pay for their behavioral health care, rather than incurring another expense. While copays might be lower than paying session fees, insurance also creates many roadblocks to your child’s care. These affect not only the quality of the services your child receives, but also the convenience of your child’s care, your confidentiality, and sometimes, even the overall cost.
Did you know?
You can still use your insurance benefits! You may have out-of-network benefits. To use out-of-network benefits, we will give you a superbill, and your insurance company will reimburse you for services rendered, according to your plan’s out-of-network benefits.
These are some of the benefits you can experience when taking your behavioral health care into your own hands and selecting an out-of-network psychologist or therapist for your child:
Most in-network psychologists and therapists are generalists. Although they are qualified to treat common conditions such as anxiety, depression, and challenges in navigating significant life events, they often lack child-specialized training in assessment and treatment of concerns occurring within the developmental context. Much like how many of us seek out a Family Practitioner or a Primary Care Physician for routine issues like the flu, we generally seek out or are referred to specialists for more specific or complex conditions, such as cardiac or neurological conditions.
Most out-of-network therapists are specialists who have niche practices, such as Savannah Behavioral Pediatrics (i.e., We specialize in child and adolescent behavior, learning, and development). If you have a specific condition or concern, it might be best to seek out and work with an out-of-network clinician or practice that has extensive training and experience in the area in which you are seeking help. If you are seeking behavioral health services for your child, it is absolutely critical that you find a provider who specializes in pediatric or child/adolescent therapy and/or assessment.
Quality of Care
For insurance companies to pay for your sessions, they require the provider to give your child a diagnosis. Many children who require behavior therapy, particularly young children, do not benefit from receiving a specific diagnosis; however, when using insurance, the provider must put a formal diagnosis on record in order to get reimbursed. That means having a diagnosis on your child’s medical record. Many clients do not feel comfortable with their young children getting a diagnosis or having one on record. Additionally, many people might have to review the diagnosis in order for the insurance company to approve payment, and they can decide to exclude diagnoses based on any justification. Insurance companies frequently deny services for behavioral health diagnoses. In fact, insurance companies have recently begun making an arbitrary distinction between “mental health” and “behavioral health” diagnoses and excluding anything they deem behavioral. When seeing an out-of-network provider, a diagnosis is not required for treatment. If your child does meet criteria for a diagnosis, it can stay between you and the provider and does not have to be documented on insurance records.
Another advantage to seeing an out-of-network psychologist or therapist is confidentiality. Insurance might seem like a way to get behavioral health care covered financially, but it comes with many caveats. Insurance companies do not simply pay for behavioral health care. Instead, they consistently monitor patients and decide if they should receive or continue to receive behavioral health services. To do this, several people at the insurance company have to review patient files, meaning people at the insurance company will be reading the intimate details of your child’s reports and notes. Most people are unaware of this and bristle at the idea when they find out. In therapy and assessment, people often want what they and their children say to be private, then find that when they use insurance, many strangers are reading about their child’s personal information. An easy way to make sure this never happens is to see an out-of-network therapist.
Psychologists and therapists who take several insurances often have very large caseloads. For this reason, people seeking therapists within their insurance often find that it is difficult to get in contact or that the practice has a long waiting-list.
Because psychologists who work with fewer insurance companies often have smaller caseloads, they tend to be more accessible, able to devote more time and energy to each family. They usually have the availability to respond to calls and emails more quickly, to accommodate new patients, and to schedule appointments without long wait times. In fact, the reason we are in-network with very few insurances at Savannah Behavioral Pediatrics is specifically to keep our wait times lower, so that we can better serve children and their families. Our wait times are typically only a few weeks, compared to several months for providers who accept several commercial insurance plans.
While paying a copay that is much less than a full session fee can seem financially prudent at first, the issues previously outlined point to more time and more money spent long-term. Research has shown that many behaviors get worse while waiting on long waiting-lists. This can lead to needing more extensive therapy, ultimately incurring a larger cost. We often have parents tell us that their child has attended one (or more) years of therapy without success due to seeing a non-specialized provider. They are then seeking our more specialized services after paying a year or more of weekly copays. Most evidence-based behavior therapy can be conducted in a short time frame, successfully meeting treatment goals within 15 sessions. Although insurance copays may be less per session, the cost of one or more years of weekly copays may be comparable to (or even far exceed) a full session fee for 15 weeks. Remember that the ultimate goal is to find the right provider, so you can help your child reach their full potential.
Insurance creates many roadblocks to behavioral health care that make quality care less accessible. It might seem more costly at first, but your child’s behavioral health care is one of the most important investments you can make. Having a strong mental and behavioral health foundation is something that can help your child achieve their highest potential. Achieving this goal can be much more difficult, time-consuming, and costly when using insurance. Using an out-of-network psychologist or therapist allows you to be more in control of the care your child receives as well as other important factors like confidentiality.