The first step to navigating insurance is understanding the difference between in-network and out-of-network benefits. Here’s a quick guide to how in-network benefits work. Read about out-of-network benefits here.
With in-network benefits, your insurance will only pay for care provided by someone who has a contract with the insurance company.
When your child gets care from a provider who is covered in-network, you don’t pay for care upfront. The provider bills your insurance company and the company pays the provider directly.
To find out if your provider is in-network with your insurance company, you can check the list on the company’s website. It’s best to ask your provider directly as well. Sometimes the insurance company’s information is out of date, or the provider might not be taking new patients with your plan right now. Calling ahead to confirm that the office takes your insurance is always a good idea.
You might have to pay a copay at the time of the appointment, which is a portion of the full cost of your child’s care. For example, if your child’s therapist charges $100 per session, you might pay a $25 copay. Then, the therapist sends the insurance company a bill for the remaining $75.
It’s important to remember that even with an in-network provider, your child’s insurance company will not pay for care until the deductible is met. The deductible is the amount that you have to pay for all your child’s health care each year before the insurance company will cover care. So if you haven’t met your deductible that year, you would have to pay the provider’s full fee until the deductible is met.
The upside of using in-network benefits is that it is usually much more affordable than using out-of-network benefits. If your deductible has been met, you only pay the copay for each session.
The downside is that it can be much harder to find an in-network provider. A lot of mental health care providers don’t accept insurance, so you have fewer providers to choose from. And those who do take insurance may not work with your particular provider. They also tend to have long waitlists.
Return to Connect to Care for more information about getting kids help.