In-network plans (often called HMOs) provide its members a network of providers, a list of doctors, therapists, psychiatrists, and dentists members can receive services from. With an in-network plan, you must see a provider in the network of providers in order for the services to be covered by your insurance company. An out-of-network plan will also provide its members with a network of providers. However, they will also allow their members to go outside the network of providers to receive services. The insurance company will cover a portion of these associated services. An out-of-network plan gives its members more freedom to choose where they receive services, but these plans are also more expensive. Project Courage is an in-network provider with Anthem Blue Cross Blue Shield and Aetna plans.
If I have an out-of-network insurance plan, what is the co-insurance?
Another way out-of-network plans encourage members to stay in-network is by having co-insurance. Co-insurance is the amount a member must pay out of pocket for services provided out-of-network, even when the deductible has been met. Co-insurance is usually represented as a percentage of the cost the insurance will cover versus the cost the member must cover. It usually ranges from 50% to 80%.For example, if an individual has an out-of-network plan with a $500 deductible and an 80% co-insurance rate, and they were going to therapy that cost $150 per session, they would need to pay the first $500 for the therapy sessions to cover their deductible After their deductible has been met, the insurance will cover 80% of the $150 per therapy session. This would leave the individual responsible for the remaining 20% or $30 per session.
Navigating insurance can be quite challenging. That’s why when clients call Project Courage, we have a service called Verification of Benefits that we provide free of charge. That means that we will call your insurance and determine your benefits so that you can receive the help you need with confidence.Once you have an understanding of the level of care you need as well as the benefits your insurance offers, you are in a much better place to receive the help you need. We want to help you understand both of these areas at Project Courage. We are very sensitive to your needs when you call us for help. The last thing you want is to feel overwhelmed trying to navigate the mental health system and trying to determine your insurance benefits. That’s why when you call us, we will be there for you, whether it’s to provide you with our services or to connect you with another provider who can help you. We stay involved until you’re in good hands.
