My Therapy Connection™ is considered at “Out-of-Network” Provider.
*In Network with Allied Trades Assistance Program* (brick layers, asbestos workers, and other trades)
Insurance carriers that reimburse for therapy:
Horizon BCBS: NJ Direct, some Aetna Plans, Some Horizon Plans
Employees who receive out-of-network benefits: teachers, State employees, employees of large companies (some)
To find out if your insurance reimburses for “out-of-network” providers, call the number on the back of your insurance card, and ask them.
Questions related to being out-of-network:
What does an out-of-network provider mean?
This means that we are not under contract with your insurance company and, therefore, you and your therapist have the freedom to determine which type of treatment is best for you. When a provider has a contract with an insurance company, the contract between the insurance company and the provider determines how they conduct therapy for all of providers’ clients. And we know that not all clients are the same and need an individualized plan. Some clients require weekly treatment, sometimes clients request longer sessions, and some clients do not want their private information shared with their insurance company.
Therapy seems expensive. What if I cannot afford it?
Before you go back to your web search, please read this particularly important information and then make your decision:
*Your insurance company may offer reimbursement (scroll down for further details). So, just because a provider says they do not take insurance does not mean you will be responsible for the entire cost.
*We can support you! If this seems tricky or overwhelming, please send us an e-mail or give us a call and we will help you figure it out!
*Therapy is an investment in you! Think about how much money you spend on eating out, going to the gym, and your kids’ activities. Many of our clients tell us they see results even after one session. If money is a concern for you, we want to know and we will develop a treatment plan that is right for you. We can talk about biweekly sessions or a set number of sessions. Perhaps you can read books from our recommended book list that will help you grow in between sessions.
*Remember, your brain, which regulates your emotions, is the most complex organ in your body. Isn’t it worth your investment to make sure it is operating to the best of its ability?
*If you are seeking couple’s therapy; there is research that states that kids who grow up in a household where the parents are emotionally connected fare better emotionally. Also, when you are feeling secure and connected in your relationship, there is a decrease in symptoms of depression and anxiety.
Why do providers elect to be out-of-network?
There are many reasons why therapists decide to be out-of-network:
First, it gives the provider and client the freedom to dictate treatment. Second, the insurance company often restricts the number of sessions a client can be treated for and the length of the session. Often, our clients need a “double session.” If we had a contract with an insurance company, this might not be allowed.
By having a contract with an insurance company, you must be diagnosed with a disorder listed in the Diagnostic and Statistical Manual for Mental Disorders (DSM), and we do not like labels. If a couple is coming into treatment for help with their marriage, this is not necessarily due to a mental disorder. If we take insurance, we must place a label on all our clients.
The insurance company has a right to the client’s confidential information. Because your insurance company is paying for service, they can request your records.
Lastly, time! It is very time consuming to deal directly with insurance companies. The authorizations, billing, reviewing contracts, tracking payments all takes a great deal of time. At My Therapy Connection™, we prefer to invest on the care that our clients receive. Therefore, we spend a lot of our resources training our clinicians and ensuring they are up to date on the most recent evidence-based treatment. We also want to take the hours that we would be spending on paperwork to help more people by doing more sessions.
Will I be responsible for the entire fee for therapy?
If you have a PPO or a Special Employee Plan, you may be eligible for reimbursement by your insurance company. For example, many NJ State Employees have Horizon Blue Cross Blue Shield or Aetna. This plan allows for out-of-network treatment. This means that you will pay out of pocket for therapy at the time of service, but your insurance company will reimburse you for a portion of the session. Most of our clients report this rate to be about 70%.
However, you are responsible for the cost in the event your insurance company does not reimburse.
My insurance company is a PPO. Now what?
You will pay for each session at the time of service. We accept cash, check, health savings accounts, and credit cards. On the first of each month, you will receive a “Superbill” from us. This is the document that you will need to submit to your insurance company for reimbursement. They will then reimburse you directly.
Questions to ask your insurance company:
You can find the phone number to your insurance company on the back of your insurance card.
· Does my plan cover out-of-network mental health treatment?
· What percentage of treatment will be covered and what percentage will I be responsible for?
· Do I have a deductible and, if so; what is it?
· What type of mental health treatment is covered (couples, family, individual)?
· Are there any diagnoses that are not covered?
· What credentials does my therapist need to have in order for me to be reimbursed?
· What do I need to submit to be reimbursed?
· Is there a limit to how many sessions I can receive?
· Can you please tell me the step-by-step process to get reimbursed?
· How long does it take to be reimbursed?
· How will I be reimbursed (what method)?
· Do I need preauthorization? If so, how do I get preauthorized?
If you have any questions whatsoever, please do not hesitate to reach out. We would hate for you to lose out because of money and there is no shame in talking about money—we get it! Let us help you make this decision to put your mental and emotional health first an easy one.
Please reach out today—we are here for you!