Finding quality mental health care in Connecticut can be challenging, especially when in-network options for experienced providers are limited. Suzanne Gallagher, an in-network psychiatric nurse practitioner (Psych NP) with UnitedHealthcare, is based in Fairfield County, CT, and treats conditions such as anxiety, depression, ADHD, and postpartum mental health. This article explores the benefits of out-of-network care as a flexible, accessible option for mental health treatment.
Why Some Providers Don’t Accept Insurance
Due to administrative complexities, low reimbursement rates, and increasing demands for paperwork, many experienced mental health providers, especially psychiatrists and Psych Nps, choose not to accept insurance. This trend can make it more difficult to find seasoned, in-network mental health professionals who can address specific needs, such as anxiety and ADHD treatment. Out-of-network care can provide greater access to experienced providers and specialized approaches that may otherwise be difficult to obtain through insurance.
What is the Difference Between In-Network and Out-of-Network Providers?
In-Network Providers: These are contracted with your insurance, generally resulting in lower out-of-pocket costs. However, high demand and low reimbursements mean wait times are longer, and some in-network providers may require monthly follow-ups for stable clients, which may increase both costs and time constraints.
Out-of-Network Providers: These providers aren’t contracted with your insurance. While initial costs can be higher, your out-of-network benefits may cover a significant portion of the expense, giving you access to more tailored, flexible treatment options.
What is a Deductible, and How Does It Affect My Out-of-Network Costs?
A deductible is the total amount you must pay for covered medical expenses, including mental health care, before your insurance begins to reimburse you. It’s often separate for in-network and out-of-network claims, meaning your deductible for out-of-network services will only apply to those claims.
For example, if your out-of-network deductible is $500, you’ll need to pay $500 for eligible out-of-network services before receiving reimbursements. This amount typically encompasses all medical claims, not just mental health.
What is a Copay, and How Does It Differ from Coinsurance?
Copay: A copay is a fixed amount you pay for each in-network visit, such as $20 for a therapy session. Out-of-network providers typically do not use copays; instead, the reimbursement depends on your deductible, coinsurance, and allowed amounts.
Coinsurance: Coinsurance is the percentage you’re responsible for after meeting your deductible. For instance, if your coinsurance is 20%, you’ll pay 20% of the covered cost after reaching your deductible.
Allowed Amount: This is the maximum amount your insurance will cover for a specific service. If your provider charges more than the allowed amount, you’re responsible for the difference in addition to your coinsurance.
Why Consider Out-of-Network Mental Health Care?
Broader Access to Specialized Care: Out-of-network benefits give you access to a wider range of experienced providers who specialize in conditions like anxiety, ADHD, depression, and postpartum care.
Reduced Wait Times: Many out-of-network providers offer quicker appointments, allowing you to start treatment sooner.
Greater Flexibility in Scheduling: Unlike in-network requirements, out-of-network providers may not mandate monthly follow-ups, offering more control over your schedule and the frequency of your appointments.
How Can I Simplify the Reimbursement Process?
To streamline out-of-network reimbursements, consider using tools like Reimbursify, which is available on Suzanne Gallagher’s website. Apps like Reimbursify, Mentaya, and Thrizer help simplify the claim submission process so you can focus on your care, not paperwork.
About Suzanne Gallagher
Suzanne Gallagher, psychiatric nurse practitioner (Psych NP), is based in Fairfield County, Connecticut. She offers specialized mental health services, including psychiatric evaluations, medication management, and ADHD testing. Suzanne is in-network with UnitedHealthcare and provides both in-person appointments at her Darien, CT office and telehealth options across Fairfield County and the state. For more information or to verify your out-of-network benefits, visit suzannegallaghernp.com.