Insurance Terminology Explained for Therapists in Private Practice

June 22, 2017

Insurance Terminology Explained for Therapists in Private Practice

There is a lot of jargon used in the field of insurance. When you start accepting clients with insurance, it might seem like a lot of gibberish at first. To help you through the process of being able to treat patients covered by insurance, we have compiled the three most important terms you need to understand:

Negotiated Fee 

Once you sign up with an insurance, they will send you a welcome letter with the terms and condition of your contract. This document usually includes a fee schedule list, outlining the maximum you can charge clients covered by this insurance for certain services.

You are not allowed to amend this agreed fee, or charge the client more. It is also fraudulent to ask clients to pay the difference between the negotiated fee accepted by their insurance, and your full fee.

In Network

It can be useful as a private practitioner to be contracted by insurance companies. Often they have different policies regarding deductibles, co-pays, co-insurance and out-of-pocket limits for therapists that are ‘in network’ rather than ‘out of network’.

 So if you are credentialed with a client’s insurance, you are said to be in network.

Insurance Terminology Explained for Therapists in Private Practice

Insurance Terminology Explained for Therapists in Private Practice

Out of Network

If you are out of network for a client, it means that you are not credentialed with their insurance company.

As a result their insurance often inflicts higher deductibles, co-pays, so-insurance and out-of-pocket costs. Therefore clients might choose a different practice over yours.

If you find yourself out of network for many potential clients, you can try and get credentialed with more insurance companies to make your services more affordable and attractive.

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