Ins and Outs of Health Insurance for Counseling (In-network and Out-of-network)

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Orlando Counseling Providing Anxiety, Trauma and Relationship Therapy

Feeling confused about the ins and outs of health insurance for counseling? Does thinking about it feel like a big pain in the "you know what?" 

In my last article, Health Insurance for Therapy? The Pro and Cons, I discussed the nitty gritty of using your health insurance for counseling and therapy. As an anxiety and trauma therapist providing counseling in Orlando, I want to help you sort out the ins and outs (in-network and out-of-network) when using your health insurance.

As I mentioned in the last article, I am a counselor in Orlando and I do not take insurance for many reasons. I have written this series of blog posts because I often get questions about using health insurance for counseling when a client first calls me about therapy in Orlando. All insurance plans are different, so you will need to call your insurance company to find out what your plan offers. This blog post is intended to help you be an informed consumer.

Before we get into the ins and outs, it is important to understand some insurance lingo.

Copay-this is a flat rate you will pay the therapist at every visit, which typically applies to in-network coverage. 

Coinsurance-this is a percentage of the session rate you will be reimbursed from your insurance company based off of the usual and customary rates in your area. This typically applies to out-of-network coverage.

(You won't pay both a copay and coinsurance. It is typically one or the other).

Deductible-this is the amount of money you need to spend on healthcare expenses before your health insurance benefits kick in. You should find out about in-network deductibles and out-of-network deductibles when calling your insurance company.

Superbill-this is a receipt your out-of-network provider will give you. You will submit this receipt to your insurance company so that you can get reimbursed for services. 

Max number of visits-This is maximum number of visits the insurance company will cover.

For the purposes of this article, I will walk you through an example of using out-of-network benefits for my client, “Ann.”

How it Works

Ann has a $1000 out-of-network deductible, which means before her benefits will kick in, she needs to spend $1000 on medical and mental health care expenses that are "out-of-network." Rather than having a flat copay, she has a 50% coinsurance, which means she is responsible for 50% of the session rate based off of the usual and customary rates in Orlando.

Additionally, she will pay for her sessions up front and then submit a Superbill to her insurance company after each session for reimbursement. After Ann meets the $1000 deductible, her insurance company will reimburse her $60 per session (50% of $120 session), so she will only come out of pocket $60 per session.

Her plan doesn't have a maximum number of sessions for out-of-network. However, I have seen some plans have a maximum limit of only four sessions. This is an important question to ask when calling your insurance company.

Understanding the ins and outs of your health insurance can be a big pain in the rump! I hope this blog post helps break it down a little. Please feel free to leave questions or comments below.

Related articles:
Health Insurance for Therapy? The Pro and Cons
Free and Reduced Fee Counseling in Orlando
10 Questions to Ask your Orlando Therapist before the First Appointment
How to Find a Therapist in Orlando

Lauran is an anxiety and trauma therapist providing counseling in Orlando, FL. She also specializes in helping people heal old broken relationship patterns that keep them from finding, creating, and keeping healthy relationships with partners, friends, and family. Lauran uses a down to earth approach infused with cutting-edge therapies that go beyond traditional talking to help clients feel calm in their body and mind and find peace within themselves.