Why You Should Consider Care with an Out-Of-Network Therapist
Making the decision to pursue therapy is a monumental choice. Most people don’t arrive in this place casually. If you have made the decision to begin therapy, chances are that there is deep dissatisfaction or unhappiness residing somewhere in your life at this moment, and you have decided that the time has come for change. We applaud your decision and affirm that you deserve a life that is healthy and happy. If you are experiencing challenges that fit within our areas of expertise, then we would love the opportunity to help you as you make the changes you need and deserve.
As you may have noticed on our Pricing page, Upward Behavioral Health does not deal directly with health insurance companies. We do not accept payment from health insurance. Like over half of America’s therapy providers, Upward’s therapists are exclusively out-of-network (OON). “Out-of-Network” or “Private Pay” simply means that the therapists at Upward have made the decision not to contract with health insurance companies to offer treatment according to those companies’ requirements in exchange for being included on those insurance companies’ panels of in-network providers. Our clients pay us directly for our services.
You may wonder why we made this decision. On this page, we will address a number of discussion points relevant to health insurance, out-of-network care, and methods for removing financial barriers to care at Upward.
Why would a therapist not accept health insurance?
Roughly half of the therapists in the United States have made the same decision as Upward and do not accept payment from health insurance companies. Increasingly, therapists are withdrawing from health insurance networks. There are a number of reasons why therapists make this decision. Here are a few:
Low payment rates, “clawbacks”, higher overhead costs, and delays in payment can destabilize a therapy practice and shift providers’ focus away from what really matters. Providers who make the decision to be “in-network” with a health insurance company agree to abide by the rules and requirements of that health insurance company, which often include the following:
- Very low payment rates which can make it difficult to hire and retain the highest-quality, best-trained, and most experienced therapists.
- “Clawbacks”, which is the term used to describe a scenario in which an insurance company agrees to pay a provider for a client’s care only to later “claw back” that payment for reasons that are often unclear or unfair. When this occurs, the therapy practice is required to return the payment for services back to the insurance company. The therapy practice must then involve itself in hours of administrative work to appeal the clawback so the therapist can be paid for the work they have done. Often these clawbacks are not appealed successfully and therapists actually end up losing time and money after delivering care to a client.
- Confusing billing practices and delays in payment which can result in therapists not being paid for extended periods of time or not being paid at all.
- The need for a practice to hire an administrative staff member solely to handles billing-related tasks, which drives up the overhead costs of the practice.
Health insurance companies routinely expect to weigh in on the level of care or the care approach that a client can receive. For example, health insurance companies often limit how many minutes a therapist can spend in a therapy session with a client, or how often a client can meet with their therapist. Therapists must often seek approval or permission to offer the care their client wants and needs. These intrusions can take away from the quality of care that a therapist can offer to a client.
Health insurance companies require that therapists disclose a client’s diagnosis, which makes many clients uncomfortable.
All of these factors can cause recurring distraction, distress, and destabilization for a client, their therapist, and the therapy practice employing that therapist. Ultimately, these are the factors which led us to make the decision to build Upward as an Out-of-Network/Private Pay therapy practice.
Why would a client with health insurance pay out-of-pocket for a therapist who is OON?
Despite the issues listed above, roughly half of the therapists practicing in the United States accept health insurance and are in-network providers with at least one health insurance company. So why not simply use an in-network therapist as opposed to an OON provider?
This is an extremely reasonable question. There are three main reasons a person would choose to use an OON network provider:
The OON provider offers something the client can’t get anywhere else. If you are looking for effective, evidence-based treatment for insomnia, nightmares, and/or CPAP desensitization, you have probably noticed that therapists who specialize in the treatment of these conditions are very hard to find. The American Academy of Sleep Medicine, American College of Physicians, National Institutes of Health, and American Psychological Association all agree that Cognitive-Behavioral Therapy for Insomnia (CBT-I) is the best treatment for insomnia. The International CBT-I Provider Directory lists a very small number of therapists in Alabama who are certified in CBT-I, and the majority of those listed therapists are employed by Upward. Upward’s therapists are certified experts in the treatment of insomnia with a proven record of success at helping clients sleep significantly better.
The OON provider can offer care sooner than an in-network provider. Particularly when clients are seeking an Autism or ADHD evaluation, they often encounter frustratingly-long wait times with other providers. Upward’s approach to care helps us keep our wait times shorter by comparison both for evaluation and for treatment. Clients who want faster access to care may choose to use an OON provider.
The OON provider possesses a level of skill, experience, training, or treatment approach that makes it “worth it” to invest in care with them. Clients may choose to see a therapist whose training, experience, and areas of expertise indicate that that therapist’s qualifications have equipped them to be especially helpful and effective. Upward’s providers have all had the opportunity to amass years of experience and state-of-the-art training in the most effective therapy approaches to treat many common mental health conditions. Our exclusive focus on evidence-based therapy allows us to offer effective, results-driven care to our clients. At Upward, clients also have the reasonable expectation that for many conditions, the course of treatment will only last 6-12 weeks, which means that the client will not be paying indefinitely for weekly appointments.
I want care at Upward but I don’t think I can afford it. Is there a way to make care with Upward more affordable?
We want to make care at Upward a possibility for as many clients as possible. Here are some points to consider as you make your decisions about your care:
Many of our clients are able to obtain some level of reimbursement from their health insurer for OON care. We suggest that you call your health insurance company to inquire about your OON reimbursement benefits for therapy or evaluation. For many clients, reimbursement from their health insurance company can help offset—sometimes considerably—the cost of care with an Upward provider. Upward is happy to provide Superbills to assist you in seeking OON reimbursement, and we are also happy to bill you through the Thrizer platform, which can help clients streamline their reimbursement claims. Navigating the OON reimbursement process can be daunting for many clients, and Upward providers can provide guidance on how to best accomplish this.
There are different price points available at Upward based on our providers’ training and experience. During your consultation call, an Upward therapist can guide you through pricing options at Upward (you can also see different hourly rates for Upward psychologists and social workers here). Some therapists’ rates are lower than others at Upward. Regardless of price points, all therapists at Upward are imminently qualified to provide evidence-based therapy for an array of mental health conditions. We also strongly encourage clients to consider small groups rather than individual treatment for insomnia, depression, and anxiety. Receiving care in a small group setting significantly reduces the cost of treatment at Upward. Research demonstrates that the treatment we offer in small groups is equivalent in effectiveness to treatment offered individually.
Upward is proud to partner with CareFund, an Alabama-based company which offers interest-free financing to clients and allows them to pay for their care in installments over a period of 6 months for clients who qualify. During your consultation call, an Upward therapist can provide you with more information about this option.
As you consider your options, we welcome you to schedule a complimentary consultation call with one of our therapists to discuss your options.