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My insurance is "out-of-network." What does that mean?

Christian Family Institute

Published: July 18, 2018

One of the most asked questions we hear is “Do you take my insurance?” We love it when the answer is a clear-cut “yes” or “no”. Unfortunately, we find ourselves frequently saying “it depends”. It depends not only on your insurance company, but on which of the dozens (or sometimes hundreds) of policy’s your insurance company offers that you might have. Just because you have XYZ insurance doesn’t mean we know which particular policy XYZ offers that you have.

For some policies we are “in-network”; for others we are “out-of network” but can still work with you and your insurance. For still others, we are out-of-network but cannot work with your insurance.

In-Network. This means that we have a contract with your insurance company. Our contract with the insurance company may spell out what we can charge, how many session we can provide, or how often we have to report back to the company on the progress being made in treatment. Some contracts are with Christian Family Institute as a group and others are with individual therapists. The therapist you originally requested may not be in-network but one of our other clinicians is; in other words, one of our therapists is likely to be able to work with you and your insurance.

The sad truth is that insurance companies are requiring more and more from therapists while paying less. Also, it appears that insurance companies have a preference for contracting with large hospital-based networks: they can do one-stop-shopping as they negotiate fees for surgery, oncology, pediatrics, etc. as well as mental health. This may mean that some companies prefer not to contract with individual providers or small groups. For these reasons we are constantly re-evaluating our insurance contracts.

Out-of-Network. This means that we are not contracted with your insurance company. Some policies will reimburse you for counseling services that are provided by a clinician who is not under contract with them. Usually you will be reimbursed at a somewhat lower rate than if you had seen someone in-network. Other policies (usually HMO’s) will not reimburse anything to you if you see an out-of-network clinician.

It is important to remember that out-of-network means we have NOTHING to do with your insurance, co-pays, or deductible. This is YOUR insurance: you are the one with a contract with the insurance company, not CFI. We may, if you request it, offer to submit claims on your behalf. We do this as a courtesy and convenience for some of our clients. It does not mean that we are offering to act as if we were in-network; it is merely a free service we offer so your counseling experience will be as simple and hassle-free as possible.

The trend among counselors is away from offering a convenience filing: more and more mental health professionals are giving clients a “super-bill” (an insurance friendly receipt) and leaving the client to navigate the insurance-billing waters completely on their own. So far, CFI has been able to resist this trend and continues to offer our clients assistance in billing their insurance.

Why see an Out-of-Network Clinician?

  1. Because we are not a large hospital-based conglomerate; we are not a bureaucracy and we don’t act like one. Each therapist has the freedom to negotiate directly with clients regarding fees, number of sessions, and payment plans. There are no layers of bureaucratic approval to get in the way of the counselor-client relationship.
  2. The name Christian Family Institute conveys our world-view and our approach to treatment. Our statement of faith is published for the whole world to see. Respect for your faith may be worth paying a little extra, if necessary, to ensure a counseling philosophy that is compatible with – and not hostile to – people of faith.
  3. We always keep the family in mind even if only one person is present in the counseling session. Marriage and family therapy is a speciality that not all therapists have training in. Yes, we see individuals for a variety of reasons; all of our counselors are licensed to diagnose and treat mental health issues. Our therapists are also skilled at working with marriage, parenting, and family issues as well. People trained in individual therapy can actually do marriages and families more harm than good when they act outside their training.
  4. The word “Institute” speaks to CFI’s commitment to training and education. CFI clinicians have served on state licensing boards, professional associations, and as university professors training the next generation of therapists. We are committed to offering continuing education to the mental health community. We are, in other words, experienced professionals who take pride in our craft. The staff of Christian Family Institute have many years of experience as leaders of their profession. Remaining on the cutting edge translates into the best possible clinical experience for clients.

“But my insurance company says… something different than what CFI has told me.” We only pass on whatever information your insurance company has told us. It is not us giving you a different answer; it is your insurance company telling us one thing and you another. Over the years we have discovered that it is possible to get an answer from an insurance company (“how much will you pay for out-of-network services?”), hang up the phone, immediately call the insurance company back, and get a completely different answer on the second phone call. Sometimes this may have to do with the fact that your insurance company has hundreds of similar policies and the clerk on the
phone simply looked at the wrong policy. Other times, it may be that you called one phone number, while we called a different number for the same company: it appears that some insurance companies are so large the left hand simply doesn’t know what the right hand is doing.

Remember: if we are out-of-network then we have NOTHING to do with your insurance (other than doing you a favor and submitting a claim for you). If your insurance company isn’t paying on a claim, then let us know and we will do all we can to help you straighten out your insurance. But in the final analysis, you are the one with a contract with the insurance company, not us. Therefore, the final responsibility for seeing that your bill is paid rests on you.

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