What OON Therapists Need to Know About Insurance

Navigating the world of insurance as a behavioral health therapist can feel overwhelming. For therapists who are not in-network providers, it’s important to communicate clearly with clients about their insurance expectations. Behavioral health professionals will also need to be well-versed in effectively discussing the superbilling process.

This guide covers everything OON therapists need to know about mental health insurance and the mental health billing process. Learning a few OON billing best practices can vastly streamline the RCM system of a mental health organization.

What Does It Mean to Be an OON Therapist?

Out-of-network therapists are providers who do not have a direct contract with insurance companies. Instead of billing insurance companies directly, OON therapists charge clients directly for sessions. Clients can ask their insurance companies for reimbursement if their plan includes out-of-network benefits for behavioral health.

Many therapists decide to be out-of-network (OON) providers. They do this to avoid extra paperwork and lower payment rates from in-network contracts. This model can offer more freedom, better rates, and the ability to focus on providing high-quality care.

However, this approach also requires more upfront communication with clients and a solid understanding of how insurance reimbursement works.

Communicating with Clients About Being OON

Clear communication is key when operating as an OON therapist. Many clients may not understand what OON means or how their insurance works. Here’s what behavioral health therapists should explain during intake sessions:

• You are an out-of-network provider and do not bill insurance directly.
• Clients will pay out of pocket and may submit superbills to their insurance companies.
• Insurance companies do not guarantee reimbursement, and coverage rates vary depending on the plan.
• Clients should contact their insurance company to verify OON behavioral health benefits before starting therapy.

Giving clients a simple guide on how to submit mental health superbills can help them manage the process on their own.

Challenges of Being an OON Therapist

Being an OON provider comes with unique challenges, including:

• Session Costs for Clients: Out-of-pocket costs can be a barrier for some clients.
• Reimbursement Delays: Clients may face long wait times for reimbursement.
• Insurance Confusion: Clients often struggle to understand their behavioral health insurance benefits.
• Marketing and Client Acquisition: Therapists may need to put in more effort to attract clients. They do not have the referral network that in-network providers enjoy.

Strategies for Success as an OON Therapist

Despite the challenges, many OON therapists run thriving practices. Here are some strategies to improve success:

1. Set Transparent Fees: Clearly outline session rates on your website and in client paperwork.
2. Offer Superbills Consistently: Automate superbill generation through software like Thrizer.
3. Educate Clients: Provide written resources or videos explaining how to verify their OON benefits and submit claims.
4. Show the Value of Your Services: Focus on the benefits of private-pay therapy. These include personalized care, shorter wait times, and often better quality treatment.
5. Utilize Directories: List your practice on platforms like Psychology Today to increase visibility.

Understanding Superbills

A superbill is an itemized receipt that therapists provide to clients after sessions. It includes the necessary information clients need to submit claims to their insurance companies for reimbursement.

Superbills typically include:

• Therapist’s name, credentials, and NPI number
• Session dates
• CPT codes (Current Procedural Terminology codes)
• Diagnosis codes (ICD-10 codes)
• Session fees
• Client information

Providing accurate superbills is essential for helping clients receive timely reimbursements. When possible, OON therapists should use behavioral health billing software to help generate compliant superbills. Do you want to understand what you need to include on a mental health superbill? Here is a helpful guide by Practice Solutions that breaks down the core components of a superbill.

Tools like CheckpointEHR can also support and streamline necessary mental health billing tasks, simplifying responsibilities for therapists.

Insurance Verification Tips for Clients

Encourage clients to ask their mental health insurance company these key questions:

• Do I have out-of-network behavioral health benefits?
• What is my deductible, and what amount have I already met?
• What percentage of the session fee will you reimburse?
• Is there a limit on the number of sessions covered?
• How do I submit a superbill for reimbursement?

Providing clients with a script for insurance verification calls (example here) can help them navigate these conversations with confidence.

OON Behavioral Health Therapists

Being an out-of-network behavioral health therapist has the ability to give you more freedom and financial security. However, it needs good communication, administrative skills, and client education. By mastering superbilling and setting clear expectations, OON therapists can build a successful practice. They can focus on both client care and business success by effectively using behavioral health billing tools.

If you are starting as an OON provider or want to improve your practice, invest in the right technology. Good client communication strategies and behavioral health tools will help you succeed in the long run.

For more insights on behavioral health billing and practice management, visit CheckpointEHR.