It is true that psychiatrists are often selective when it comes to the health insurance plans that they accept. In fact, a psychiatrist may decide that he/she does not want to accept any health insurance plans. This selectivity not only allows them to control how much they will charge for services, it also gives them an opportunity to develop and adhere to their own clinical and billing standards.
Although most health insurances, like the preferred provider organization (PPO) plan offer some payment for out-of-network services, others, like the health maintenance organization (HMO) plan neglects to pay for any out-of-network services.
It is important to understand that an out-of-network psychiatrist is one that has not entered into a reimbursement agreement with your insurance. Payment is typically reimbursed at a negotiated rate. Health insurance plans like HMOs typically will not reimburse out-of-network psychiatrists. In other words, you, as the patient, are responsible for all charges associated with your office visits, counseling sessions, psychiatric evaluations and diagnostic tests.
Moreover, if you choose to see an out-of-network psychiatrist, the amount you are required to pay, as a patient, will be higher than it you were seeing an in-network provider. Although it may cost you more out-of-pocket money to see an out-of-network psychiatrist, there may be times when it is better for you to see an out-of-network psychiatrist rather than an in-network provider.
Reasons for seeing an out-of-network psychiatrist include:
There may be times when you experience such severe emotional distress and/or psychological turmoil that emergency psychiatric care is required. During these times, you may have to see an out-of-network psychiatrist because you are unable to see your regular provider.
Thankfully most plans do cover some out-of-network services, especially if they consist of severe mental illness (clinical depression, panic attacks, eating disorders, etc.) and/or emergency situations (suicidal and/or homicidal ideations). It is important that either you or a loved one contact your primary care physician (PCP) and health insurance company as soon as possible (within 48 hours) if you experience an emergency that requires out-of-network psychiatric care.
If you live in a rural area where there aren’t any practicing psychiatrists, you may need to see an out-of-network provider. Moreover, if you need a psychiatrist that specializes in a certain areas such as: child and adolescent, addiction, forensic, geriatric or adult psychiatry, you may need to seek treatment from a non-participating psychiatrist.
In addition, you may need to seek medical care from an out-of-network psychiatrist if you experience emotional and/or psychological distress while away from home. For example, if you experience a panic attack or anxiety, while working away from home, visiting relatives and/or friends or vacationing with loved ones, you may need to seek medical care from a psychiatrist that is not in your health insurance network.
In these situations, there is a good chance that your health insurance company will accept the in-network services rates, but it is important to contact your health insurance company to see how location affects service rates.
Natural disasters such as hurricanes, floods, widespread fires and tornadoes can cause you to leave home in order to seek shelter. When this occurs you may be away from home for long periods of time. If you need to see a psychiatrist for your psychological condition and/or mental illness, you may have to seek treatment with a provider that is out-of-network. Moreover, if the federal government declares that your state is in “state of emergency,” you may be able to receive in-network benefits for the services you receive from a non-participating psychiatrist.
If you have a chronic and/or severe mental illness such as: clinical depression, manic depression, anxiety, etc., and your health insurance plan does not include these types of mental illnesses, seeking treatment with an out-of-network psychiatrist may be required to maintain your mental health and psychological well-being.
If you are seeing an in-network psychiatrist for depression, anxiety, etc. on a regular basis and he/she leaves the network, it may be in your best interest to continue seeing the same psychiatrist you started with, even if it means receiving services from an out-of-network provider.
It is important to note that you may be able to receive in-network service rates, even if it is only for a set number of visits or for a specific amount of time. Contact your health insurance company for more details on how you can receive in-network coverage when your psychiatrist leaves the network.
Advantages to Out-of-Network Psychiatric Care
There are many reasons who you should seek out-of-network care such as:
You are free to seek treatment from any psychiatrist, hospital and/or facility that you choose.
You do not have to obtain a referral from your PCP to see a psychiatrist.
You are not required to get health insurance pre-authorizations for psychiatric evaluations, diagnostic tests, counseling sessions or medications.
You do not have any geographic limitations, in regards to psychiatric services.
Most health insurance plans cover some out-of-network charges.
You medical history is kept confidential. In other words, when you see an out-of-network psychiatrist you do not have to submit claim forms to your insurance company, therefore your medical history and services rendered stay strictly between you and your psychiatrist.