[acceptance]

anyone use out of network provider. how much do u pay?
what is the paper work..just receipt and one form?
how r u reimbursed?

out of network...but ur insurance still covers a portion of payment...

My therapist is out of network. She files my claims for me. I pay 100% of her fee until my deductible is met, after that the insurance company pays 70% of what they think she should charge and I pay the difference between that and her total fee.

To add to the confusion, the insurance company only applies what they think she should charge to my deductible. So, let's say her fee is $120, the insurance company says she should be charging $85 - that's what they apply to my deductible (event though I'm paying $120) and that's what they calculate the 70% on once the deductible is met. She doesn't lower her fee - so I pay the difference.

[acceptance]

Originally Posted by ByStarlight

My therapist is out of network. She files my claims for me. I pay 100% of her fee until my deductible is met, after that the insurance company pays 70% of what they think she should charge and I pay the difference between that and her total fee.

To add to the confusion, the insurance company only applies what they think she should charge to my deductible. So, let's say her fee is $120, the insurance company says she should be charging $85 - that's what they apply to my deductible (event though I'm paying $120) and that's what they calculate the 70% on once the deductible is met. She doesn't lower her fee - so I pay the difference.

ouch that sucks.
T i want to go n see...charges 175$ per session...no way my insurace will agree to it..they will probably cut that in half...and apply the percentage.

[skeksi]

Every insurance company and provider is different, unfortunately. My psychiatrist is out of network and does not file on my behalf, so I pay his fee in full and then submit a form and a receipt to my insurance company and they reimburse me about 80% of the fee. My counselor submits on my behalf even though he is out of network, so I pay him the 20% copay and the insurance company pays him the 80% balance when they get the paperwork.

My last therapist was out of network. I paid for all my sessions up front and my therapist gave me a receipt. Every other month, I'd ask my therapist for a letter that included the necessary information: my name, date of birth, diagnosis, dates I was seen and amount I paid. I'd then fill out my insurance companies form for out of network services and send it in. Then I'd wait. It often took three months to get reimbursed. BUT they would pay me the full amount once my deductible was met, and I am very lucky to have a very low deductible. I would bank the money and then use it for more sessions. It was hard to pay up front and then have to wait to be repaid, but it was worth it because she was an excellent therapist and was worth the money. It is sad though that they took so long to repay and I personally feel that they might have given out of network services lower priority to repay than in network services.

[LonesomeTonight]

It depends on the T and the insurance, as others have mentioned. I'm somewhat lucky in that my T's office files the paperwork for me with my insurance--many of them don't do that if they're out of network, so you'd have to take of that your self. So that's a good question to ask. For where I go, I pay the full amount up front ($130 for my T, $175 for marriage counselor, $125 for 25-min med check with p-doc), then after meeting deductible, get checks from my insurance company for 60% of the cost. You should be able to check with your insurance and see how much they'll pay.