Finding a Therapist: What’s the difference between an In-Network and Out-of-Network Therapist?
Disclosure, I’m an an Out-of-Network provider for all but one insurer. The single network I am a part of, the student insurance provided by Columbia University, is a sentimental attachment to those students and their institution. I attended school there, I later trained in the health service as a post-doc, and my early practice was largely built through referrals from there.
On a weekly basis I’m contacted by ex-patients, new patients, relatives, friends, “friends of friends”, etc. asking for my help in finding a good therapist. I truly love helping with referrals. Ever since my sister-in-law confessed to me 20 years ago that she found a therapist in the Yellow Pages (remember those?) I’ve considered it (mostly ) a pleasure and privilege to help someone find the right therapist. It’s also very aligned with my self-interest. If a person has a positive experience with a therapist, it’s a win for my field, and in a general way, a win for my practice.
What makes assisting with referrals difficult is the ever increasing need to choose from within a network of providers. This is a growing trend, and very much restricts your choices and my ability to refer. I’m writing this post in order to address that restriction and speak to the consumers of psychotherapy who are constantly asked to grapple with it: what is the difference between in-network and out-of-network therapists?
Talk Therapists of all types:
From the practitioner’s point of view the salient features of belonging to a network are twofold:
Network membership provides a steady, and largely passive source of referrals.
Network membership limits the dollar amount a practitioner can earn for providing a service.
It’s pretty obvious how the first feature works, and why practitioners like it. It’s largely invisible how the second feature works, and yet it’s really critical for the consumers of mental health services to understand. To illustrate how this works, my full fee is currently $275.00 for a 55 minute session. As a network therapist I would have an agreement with the insurer that I will work for “their rate” which ranges from 70-100 dollars. Typically the patient will also contribute to that in the form of copayment. So the insurer might pay me $80 and the patient may have a copay of $20.00. I would be working for $100.00 per session.
That being said, what’s the difference between these groups? In-Network and Out-of-network?
In-network therapists need a source of referrals. Often they are less established, and looking to build a practice. Alternatively, they may be less skilled, less helpful, and for those reasons have not established a referral base apart from networks.
In-network therapists are working for a lower wage, and just like your internist (who must see 5 patients in an hour) that may translate into providing less service. Rather than less time per contact, they offer less availability between appointments. From the patient point of view, this lower level of service can be experienced in: slower response to communications, less accessible by fewer means of communication, or less flexible with regard to scheduling on an as needed basis. When coordinated care between types of providers is necessary, the availability of your therapist makes a great deal of difference. Need a psychiatrist, a reading specialist, an ADD coach? You’ll rely upon your therapist’s network and their willingness to contact her colleagues on your behalf. Reaching out to other providers takes a lot of time.
Out of network therapists have a stronger referral base and hence are unwilling to work for a network negotiated reduced rate. They are paid a higher fee and generally provide a level of service not found within networks. Often they will reduce their fee, based on financial need and availability of time in their schedule. Out-of-network therapists prefer to maintain control over which patients they offer reduced fees.
Psychiatrists
Here, the gap between in- and out of-network is an even starker contrast. In my experience young psychiatrists looking to build a practice will often belong to insurance networks. Once they can do without the steady source of referrals they will no longer participate in networks. Because Psychiatrists are fewer in number (than talk therapists), in high demand, and often urgently needed, they typically don’t need to remain in-network for long.
If a psychiatrist is in-network, they are generally responsible for a large quantity of patients and often cannot provide a high level of service between appointments. If you run out of meds, are traveling and forgot your ADD or sleeping meds, or are having panic attacks, it will be difficult to get a quick response from an in-network psychiatrist. I’ve even been told, by a network psychiatrist, “if the patient needs that level of attention, you need to find another practitioner.”
In terms of Child and Adolescent Psychiatrists, who are even fewer in number, most are entirely private pay.
