Insurance companies often have specific guidelines for providers to follow. By not being constrained to the services that are billed to an insurance company, your provider at Simply Psych Nursing would be able to spend more time and creativity crafting the right treatment plan for you. This is especially important if you would like to spend more than just 10-15 minutes with your mental health provider. This extra attention may benefit your progress.

Have you ever had a medical or mental health appointment that only lasted a total of 15 minutes face to face with your provider? This is too common of an experience which does not leave space to coordinate individualized care. Many are working under the scope and time limitations insurance payors place on them.

Simply Psych Nursing offers both psychotherapy and medication management, which allows for a more comprehensive understanding of your mental health needs before and during prescribing.

A deductible is the amount you have to pay upfront before your insurance coverage kicks in.

For example, if you have a $4,000 deductible plan and you haven’t had any other medical expenses yet in the year, you are responsible for paying up to $4,000 for health-related service fees out-of-pocket before your standard copay applies. This is a case where seeing an in-network versus an out-of-network provider can accrue effectively the same cost yet you could benefit from or prefer the personalization of a private practice provider. Always check with your insurance plan to ensure you have the best understanding of your benefits.

If you have good out-of-network benefits, your insurance company may reimburse you as much as 80% of each appointment fee, depending on your plan and the provider’s rate.

This means that in some situations, using your out-of-network benefits can actually be more affordable or comparable to your standard copay when seeing an in-network provider.

Privacy from your family and/or parents.

If you are on your parent’s or a shared insurance plan and are uncomfortable with them knowing you are seeing a mental health provider, you might consider paying out-of-pocket.

Privacy from your health insurance company.

In order for your insurance to pay for (or reimburse you for) appointments, providers are required to give the company information regarding your appointments, including a diagnostic code. If you don’t want your insurance company to have access to any information about your mental health, consider out-of-network options in which you do not plan to have insurance reimburse you for.

* Note: Since this also means you will not use out-of-network benefits, appointment fees may add up significantly. If you have financial limitations and explain the situation, a sliding scale fee schedule may be considered.

Often times, finding an in-network provider with immediate openings is rare. It is not uncommon for many to be told they are on a waitlist of greater than 4-6 weeks to have an initial appointment with a provider. Other times, it can be longer. Typically, it is not until we feel we really are in need of care before the first contact or inquiry is made. Delaying your access to care may delay your chances of feeling better or even put you more at risk if symptoms worsen during that waiting period.

At the end of the day, your relationship with your provider is one of the most important aspects of the healing process.

If you only consider in-network providers, you might eliminate providers who would be a really good fit for you. This can result in a transfer or termination later down the road due to “lack of rapport” which only delays your road to recovery and may also cause financial burden and disruption in care — your mental health is worth it.

If you were already working with a provider you really liked and your insurance company changes (you graduate school, you get off your parent’s insurance, you switch jobs, etc.), don’t panic! First step- check with your insurance for any out-of-network benefits! It may still be affordable to see your provider using out-of-network benefits.