Out-of-Network Billing

In my own practice, I’ve chosen to steer clear of working directly with insurance companies.  My reasons for this are many, including preserving client confidentiality, continuity of care, and freedom from administrative and billing complexities.

Of course, there are also good reasons to consider accepting insurance, such as affordability for prospective clients and expanding your network of referrals.

If you do choose to remain private pay, you’ll still get some requests from clients who’d like to pursue reimbursement for working with you as an out-of-network provider (you might also want to educate prospective clients about this as an option).  Clients typically incur a higher out-of-pocket cost working with an out-of-network provider than they would working with an in-network provider, but a lower out-of-pocket cost than they would by forgoing use of insurance altogether.

In these cases, I provide clients with suggested questions for verifying out-of-network coverage (you can find my list of suggested questions here) and inform them that I can provide them with a monthly superbill (a receipt containing the basic information required by insurance companies to request reimbursement; most practice management systems will generate superbills for you automatically once you’ve selected that option for a particular client).

I also inform them that they’re still responsible for full payment to me at the time of our sessions, as well as my fee for appointments missed without 48 hours’ notice (most insurances will not reimburse for missed sessions and I don’t include missed sessions on superbills).  Be sure to also create a form that outlines these policies and allows you to obtain their written consent.

For those of you interested in working with insurance, check out Barbara C. Griswold’s site: Navigating the Insurance Maze.