How Out-of-Network Insurance Reimbursement Helps Therapists Retain Patients in Their Practice

As a mental health therapist, one of your top priorities is likely to help your clients receive the care they need to improve their mental health and well-being. However, the cost of therapy can be a barrier for many people, especially if they don't have insurance or their insurance doesn't cover their preferred therapist. Out-of-network insurance reimbursement can help alleviate this barrier and enable therapists to retain more clients in their practice.

Nirvana specializes in mental health coverage checks and price transparency for practices of all sizes. We offer insurance solutions for solo therapists, group therapy practices, mental health startups, and mental health collectives of over 1,000 clinicians!

What is out-of-network insurance reimbursement?

Out-of-network insurance reimbursement is when an insurance company reimburses a policyholder (client) for a portion of the cost of seeing a healthcare provider who is not in their network. This can include therapists, psychiatrists, and other mental health professionals. 

Clients with PPO (Preferred Provider Organization) plans are typically covered for routine out-of-network healthcare. Some of these plans cover in-network and out-of-network care at the same rate, while others discount in-network care. Typically, a client must spend a certain amount on out-of-network healthcare costs to reach their deductible before any reimbursement is issued to them.

Why is out-of-network insurance reimbursement important for therapists?

For therapists, out-of-network insurance reimbursement can be a crucial way to help their clients afford the care they need. Many people are willing to pay out-of-pocket for therapy but the cost can still be a significant burden. Helping clients navigate their insurance is one way a practice can express empathy for price sensitivity and reward clients for their business. Making the out-of-network insurance reimbursement easier also helps therapists make their services more accessible and affordable for their clients. 

Additionally, out-of-network insurance reimbursement can help therapists retain clients in their practice. Uncertainty about the ability to continuously afford therapy creates anxiety and has led clients to discontinue treatment altogether. Insurance aims to alleviate some of that uncertainty but its confusing nature often adds to the stress. When clients are able to afford the care they need, they are more likely to continue coming to therapy and make progress in their treatment. This can be especially important for clients with chronic mental health conditions, who may need ongoing therapy to manage their symptoms.

Why therapists should prioritize patient retention

Retaining clients is an important concern for therapists, as it can have a significant impact on the success and sustainability of their practice. Here are several reasons why therapists should care about retaining their clients:

Continuity of care: Retaining clients helps ensure continuity of care, as clients are able to receive treatment over an extended period of time. This can lead to improved overall health for the patient.

Improved outcomes: Clients who receive consistent and continuous care are more likely to experience positive outcomes from therapy. This can include reduced symptoms, improved functioning, and increased well-being.

Increased income: Retaining clients can also result in increased income for therapists, as clients are more likely to continue paying for therapy over an extended period of time.

Building a positive reputation: Therapists who are able to retain their clients are more likely to be viewed as effective and trustworthy practitioners. This can lead to increased referrals and a positive reputation in the community.

Strengthening the therapeutic relationship: Retaining clients allows therapists to build a strong therapeutic relationship with their clients. This can be beneficial for both the therapist and the patient, as it can lead to increased trust and improved communication.

‍Improved patient satisfaction: Clients who are able to receive consistent care from their therapist are more likely to be satisfied with the care they receive. This improves patient loyalty and leads to a positive reputation for the practice.

Strategies for Improving Client Retention

We’ve addressed why client retention is important above. Now let’s talk about how to make it happen. It’s important to keep in mind that client retention is affected by factors both within and out of a therapist’s control. For example, a client's transportation method, financial situation, and external obligations can make attending therapy difficult at no fault of the therapist. Luckily, there are several strategies therapists can use to retain their clients regardless of circumstances. We’ve listed a few below:

• Providing high-quality care
• Promoting open communication and setting expectations early on
• Offering flexible scheduling options
• Offering flexible or multiple payment options
• Being punctual and limiting wait times before sessions
• Encouraging and helping clients reschedule a missed or canceled session 
• Being proactive in addressing any issues or concerns that their client may have
• Being willing to make changes as needed to better meet client needs

In conclusion, retaining clients is an important concern for therapists, as it can have a significant impact on the success and sustainability of their practice. By understanding the importance of retaining clients and implementing strategies to do so, therapists can ensure that they are providing the best possible care for their clients and building a successful and sustainable practice.

How Nirvana can help enterprise mental health providers 

For enterprise mental health providers, we recommend our Coverage API. Nirvana’s Coverage API is the engine behind all of our products and it can be rented to help deliver benefit and eligibility information directly to prospective and existing clients. It can be integrated into apps, websites, and other products, and supports eligibility checks for in-network, out-of-network, and complex employer plans.

Our API delivers accurate and instant eligibility checks and ensures that mental healthcare providers can be adequately reimbursed for the services rendered to their clients. It can also help do the following:

1. Improve cost transparency
2. Improve client and insurance collections
3. Streamline client sign-up flows via faster coverage checks
4. Reduce claim denials and rejections down the line

For data security purposes, our API requires certain inputs in order to verify insurance benefits but the way these inputs are collected and the way information is then returned to clients is up to you! Compared to our Out-of-Network Reimbursement Calculator (see How Nirvana can help private-pay therapy practices below) which is also powered by our API, customers using direct API integration have more control over the interface and user flow of their client’s benefit checks.

How Nirvana can help private-pay therapy practices

We know insurance is opaque for clients and therapists alike. An unfortunate reality of insurance is that many clients have no idea if they actually have out-of-network benefits. Naturally, they then reach out to their provider for help. Nirvana seeks to bring transparency for everyone involved by pairing easy-to-use technology and high accuracy rates with top-notch customer service. With Nirvana, therapists are able to tell clients exactly what their network benefits are and approximately how much their reimbursement will be. 

Nirvana’s Out-of-Network Reimbursement Calculator is traditionally used by therapy practices with 50 therapists or fewer. This is because the Calculator is quick and easy to install (and doesn’t require assistance from an engineer or web developer). It was designed to be a self-service tool for clients that demystifies out-of-network mental health benefits and methodically estimates their out-of-network reimbursement for various psychotherapy services. 

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Nirvana’s Reimbursement Calculator has become an important part of many practices’ daily operations. It has helped therapists (like Tracy and Jessica) attract new clients, retain their existing clients longer, spend less time on administrative work, and even make intimidating transitions like fee increases and insurance network status changes easier. Read more about the amazing benefits of this product and how therapists maximize its usefulness in our recent blog post!