Why Choose an Out of Network Provider?
When choosing a healthcare provider clients are faced with the choice of selecting an in-network provider versus seeing one outside of their network. Sometimes, with an HMO plan, the choice is made for you – you do not have out-of-network coverage. Other times, your insurance plan may pay if you see an out of network provider, but will typically provide reduced coverage and higher deductibles / co-insurance for the services. So, the question becomes, “why choose an out-of-network provider in the first place?”
To answer this important question, it is necessary to understand how insurance companies form a network of providers. This process is accomplished through “insurance paneling” where a healthcare provider agrees to accept the preferred insurance rates for whatever services they are providing and to waive the difference between their usual and customary charges and the contracted insurance rate. So, let’s say that the in-network psychologist charges $200 for a 60-minute office visit. The insurance company contracts with this provider to offer psychological services to its members. The psychologist agrees to accept the contracted insurance rate of $126 for this same 60-minute office visit and to write-off the difference between the two rates. The member is not responsible to pay this difference in cost.
Now, many specialty healthcare providers have fundamental disagreements with how traditional insurance companies operate. For example, they may feel slighted in needing to discount their rates and may not need to discount their rates because of the shortage of supply of specialty healthcare providers in their geographical area. They may also resent needing to wait sixty days or longer to get paid by the insurance company and may simply not participate as in in-network provider on most insurance plans.
The end result of this is that many clients can face a shortage of high-quality specialized healthcare providers on their insurance plans. At GBH, we recognize this problem and have sought to provide an option for truly exceptional, specialized behavioral healthcare at affordable prices. We do not participate as in-network providers for any insurance or employee assistance program. However, we have set our rates about 50-75% lower than most other usual and customary fees charges by insurance-based providers. So, using the above example of the psychologist charging $200 for a 60-minute office visit and the insurance allowing $126 for this visit. We charge only $80 for the same 60-minute office visit. The average insurance deductible nowadays is creeping up toward $4000 – meaning that you may well get straddled with paying this $126 fee each time you see your in-network psychologist versus seeing us out of network and paying only a fraction of the cost.
Please Contact Us to discuss how we can save you money providing excellent quality behavioral healthcare as an out-of-network provider.