What Does “Out-of-Network” Care Mean?

After 30+ years as an academic leader in mental health and as a mom of four kids, Dr. Egger, the co-founder of Little Otter, knows that it is very hard to get quality mental health care for your children and your family. She also knows that mental health care is as important as physical health care and that investment in mental health care for children lasts a lifetime.

One big barrier to getting mental health care, both for adults and children, is that insurance coverage for mental health care is not equal to coverage for physical health care.

Many insurance companies have different benefits for “in-network” providers and “out of network” providers of mental health care. More than 80% of mental health providers in the US provide fee-for-service, “out-of-network” care.

The difference between “in-network” and “out-of-network” mental health care

Mental health care providers sign a contract with an insurance company to provide care at a set rate. The patient pays a co-pay for each session.

Some insurance companies also offer “out-of-network” benefits where they pay a part of the cost of your mental health care with an “out-of-network” provider. Here you find a provider, pay for the session, submit a claim to your insurance company, and get a percentage of the cost reimbursed by the insurance company.

Why it’s so hard to get “in-network” mental health care

It’s tough to access “in-network” mental health care. A 2017 study showed how hard it is to get an “in-network” child psychiatrist appointment:

• Only 50% of the calls made were returned.

• Of those who  answered, only 17% had an appointment available.

• The mean wait time for an appointment was 43 days. 

Why is this such a challenge?

For one, the majority of US mental health care professionals provide “out-of-network” care. This is because insurance companies often pay far below the market rate for a therapist’s service. They also may have criteria for coverage; if your mental health challenge doesn’t meet these criteria, you could be denied care. 

From the patient side, “in-network” providers can be hard to find. They are often not taking new patients or have long wait-lists. It can also be hard to find care based on quality or expertise.

This is a big problem in getting mental health care kids, especially young children.

How Little Otter supports families

At Little Otter, we provide integrated, measurement-based, top-quality care to children 0-12 and their families. We also provide the full continuum of care, from parent coaching to treatment - not just care for specific mental health disorders. 

We are also here to help you understand your insurance’s mental health benefits and get reimbursed by your insurance company for Little Otter services. 

Your Little Otter Care Leads will help you navigate your mental health insurance benefits with our complimentary insurance support program.

When you join Little Otter family, you can share your health insurance information with us, and we will look up your mental health benefits. We will then walk you through the out-of-network reimbursement process. After you pay for your session, we give you what is called a superbill. A superbill is an itemized receipt for the services you received that can be submitted to your insurance company. Each company has its own process for submitting for “out-of-network” benefits (didn’t we say the system is broken?). If you have a HSA/FSA account, you can also use funds for Little Otter services.

Remember, your Little Otter Care Lead is here for you! Questions will come up while you are receiving care and your Care Lead is here to answer questions.  

Take your first step, and register for the Little Otter app today!