When searching for therapy services, cost is certainly a factor. Fortunately, insurance plans often cover behavioral health services like counseling and therapy, but in some cases, your plan may not be accepted by a specific counseling facility. Or, perhaps, you don’t have an insurance plan that covers behavioral health. In this case, there are ways to access therapy and keep your costs reasonable, including out-of-network benefits and self-pay therapy options

Out-of-Network Benefits

If the counseling facility you select does not accept your insurance plan, you may be able to access out-of-network benefits to help with the cost of your services. When an insurance provider has a contract with the facility where you receive counseling, the facility is said to be in-network. This means they have negotiated an agreed-upon rate for services, and your insurance plan will pay that rate. 

On the other hand, if a facility is out-of-network, this means there is no contract between the facility and your insurance provider. This doesn’t mean that your insurance company won’t pay for services; it simply means that the services could cost you a little more out-of-pocket than if the provider was in-network with your insurance. You may need to pay for the services upfront and submit a bill to your insurance company for reimbursement.

Consider the following example: 

Your insurance provider is in-network with a counseling facility, and they have agreed on a contracted rate of $100 per session. Even if the facility typically charges $150 per session, your plan will cover the $100, and the facility cannot bill you for the $50 difference. On the contrary, if your insurance plan is out-of-network with that provider, your plan would cover the $100, and you’d be billed for the $50 difference.

In the end, using out-of-network benefits to cover therapy services will likely cost you more compared to using in-network benefits. However, the cost is still lower than what you’d pay out-of-pocket with no insurance. If your preferred facility is not in-network with your insurance provider, it’s still worth exploring the option of using out-of-network benefits. You may incur some out-of-pocket costs, but that may be preferable to choosing an in-network facility that isn’t actually your first choice. 

Therapy With No Insurance Coverage

If you don’t have insurance or your plan doesn’t cover behavioral health services, there are still options for accessing therapy. Many facilities have a flat rate for therapy sessions, and you can choose to self-pay for services, meaning that you directly pay the counseling facility, rather than asking them to bill an insurance provider to cover the costs. 

When you choose to self-pay for services, it may be beneficial to ask the counseling facility about working out a payment plan with you. Many facilities will also allow you to use a credit card to cover services, which may make therapy more accessible. 

If you’re unable to afford cash payments, some facilities may receive funding to allow them to provide income-based payment plans. This means that your fee will depend upon your income; in some cases, services may be free. You can locate facilities that offer this option by searching for providers that offer a sliding fee scale. If you’re looking for a therapy provider, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a search tool that allows you to find services near you. Results will indicate forms of payment accepted by the facility, including whether they accept government funding. 

For those seeking therapy services in the New Jersey area, Bridge to Balance offers several options. We may be in-network with your insurance provider; if not, you may be able to access services under out-of-network benefits. Contact your insurance company to determine what is covered. For those who cannot use insurance, we accept cash, credit cards, and personal checks. Contact us today to schedule an appointment at our Voorhees, Piscataway, or Hamilton office. 

Sources:

1)https://www.cigna.com/knowledge-center/in-network-vs-out-of-network

2)https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2021.21040338

3)https://www.samhsa.gov/sites/default/files/programs_campaigns/ccbhc-criteria.pdf