The Difference Between In-Network and Out-of-Network Insurance Billing for Mental Health

Understanding in-network and out-of-network insurance billing for mental health practices is a common pain point for both patients and providers. In this blog post, we will explore the differences between in-network and out-of-network billing and what they mean for you as a patient or a provider.

What Does it Mean to be In-Network and Out-of-Network?

When an insurance company has a contract with a mental health provider, the provider is considered to be "in-network." This means that the insurance company has agreed to pay a certain amount for services rendered by the provider, and the provider has agreed to accept that amount as payment in full. Patients who see in-network providers typically have to pay less out-of-pocket for their care than they would for out-of-network providers.

On the other hand, when a provider is not contracted as part of an insurance company's network, they are considered to be "out-of-network." This means that the insurance company may not cover as much of the cost of care, and patients may have to pay more out-of-pocket. Additionally, out-of-network providers may charge higher rates than in-network providers, which can also lead to higher costs for patients.

Understanding Providers Who are In-Network and Out-of-Network

It's important to note that different insurance plans within a single insurance company may have different networks, so even if a provider is considered in-network for one insurance plan, they may not be considered in-network for another. For example, BCBS may offer an HMO plan and credential therapists to provide in-network services to those individuals that have an HMO plan. This means that a provider is considered out-of-network for PPO clients even though they are credentialed and in-network with the HMO plan in the same insurance company. Additionally, some insurance plans may have a limited network, which means that there are only a small number of in-network providers to choose from. In that case, patients may have to go out-of-network in order to receive the care they need.

It is always a good idea for patients to check with their insurance company to see which providers are considered in-network for their plan before scheduling appointments.

Billing In-Network and Out-of-Network

As a mental health provider, it is important to understand the billing process for both in-network and out-of-network patients. If you are in-network with an insurance company, you will typically have to submit claims and accept the payments that the insurance company offers. If you are out-of-network, you may have to bill the patient directly and then help them file for out-of-network benefits using a superbill. Practice Solutions offers assistance for both in-network and out-of-network billing for mental health providers. We take care of your billing for you, and your biller is there to support you with any insurance related questions so that you can focus on taking care of your patients.

In conclusion, in-network and out-of-network insurance billing for mental health practices can be complex. It's important for patients to understand the differences between the two and to check with their insurance company to see which providers are considered in-network for their plan. For providers, understanding the billing process for both in-network and out-of-network patients is crucial to ensure that they are reimbursed for the services they provide.