3 Reasons Why Being an Out-of-Network Provider May Not Benefit Your Clients' Cost-Share

As a mental health provider, deciding whether to accept insurance or operate as an out-of-network provider is a significant choice that can impact both your practice and your clients. While being out-of-network may offer particular advantages, such as more flexibility in setting your rates and fewer administrative burdens, it can also present substantial financial challenges for your clients. In this blog, we’ll explore three key reasons why being an out-of-network provider might not benefit your clients regarding their cost-share, potentially creating barriers to accessing the care they need.

Higher Out-of-Pocket Costs for Clients Seeing Out-of-Network Providers

One of the most immediate and impactful consequences of being out-of-network is the potential for higher out-of-pocket costs for your clients. Clients seeking services from out-of-network providers often face higher deductibles, copays, and coinsurance rates than in-network care. For example, a client might have a $500 deductible for in-network services but a $1,500 deductible for out-of-network services. This means that before their insurance even begins to cover any portion of the cost they must first pay the higher out-of-pocket amount.

These increased costs can deter clients from seeking necessary care or cause significant financial strain, especially for those who require ongoing treatment. While some clients might be willing to pay more for the perceived value of out-of-network care, many may find these higher costs unsustainable, leading to skipped appointments, delayed treatments, or even discontinuing care altogether.

Limited or No Reimbursement from Insurance

Another critical issue clients may face with out-of-network care is limited or no reimbursement from their insurance plans. While some insurance plans offer partial reimbursement for out-of-network services, others may provide little to no coverage, leaving clients responsible for the total cost of treatment. This lack of reimbursement can be a significant financial burden, especially if clients expect their insurance to cover some expenses.

For example, a client might anticipate receiving 50% reimbursement for out-of-network therapy sessions, only to discover that their plan only reimburses a small fraction of the cost or denies coverage entirely. This scenario can lead to unexpected financial stress, as clients are left to pay significantly more out-of-pocket than they initially thought. The uncertainty around reimbursement can also make it difficult for clients to budget for their mental health care, leading to potential interruptions in treatment.

Complex and Time-Consuming Claims Process

The administrative burden of filing out-of-network claims can also be a significant deterrent for clients. Unlike in-network services, where providers typically handle the billing and claims process directly with the insurance company, out-of-network clients are often responsible for submitting their claims to the insurer. This process can be complex and time-consuming, requiring clients to navigate confusing paperwork, understand insurance jargon, and follow up on claims to ensure they are processed correctly.

For many clients, especially those already dealing with mental health challenges, the stress of managing out-of-network claims can be overwhelming. Delays in processing claims or errors in submission can lead to further frustration and, in some cases, result in clients never receiving the reimbursement they are owed. This additional administrative hassle can create a negative experience, making clients less likely to continue treatment or seek necessary care.

Conclusion

While being an out-of-network provider offers specific benefits to your practice, it’s essential to consider the potential downsides for your clients, particularly in terms of their cost share. Higher out-of-pocket expenses, limited reimbursement, and the complexities of the claims process can all create significant barriers to care, ultimately impacting your client's ability to access the mental health services they need.

As you evaluate your options, you must weigh these factors carefully and consider how your decisions will affect your practice and your clients. If you’re uncertain about the best path forward, consulting with experts at Practice Solutions can help you navigate these challenges and make informed choices that benefit everyone involved. By prioritizing your clients’ financial well-being, you can ensure they continue receiving the high-quality care they deserve without unnecessary financial strain. Being an in-network provider doesn’t need to result in headaches over insurance billing with support from Practice Solutions.