What is reimbursement?


I’m 16 years old and trying to get a therapist. My mom told be I need to make sure they’re covered by my health insurance. I haven’t had any luck finding a therapist that is covered by my insurance. I called one that wasn’t covered to see if they could help me out, and they told me about reimbursement, I can call my insurance and see if they can reimburse me for services by Out of Network providers. I don’t understand what any of this means, somebody please help

In: Other

You may be able to pay for the services up front, and after submitting documentation regarding the visit to your insurance, they can pay you the appropriate amount for an out of network provider visit.

It means the therapist doesn’t take the insurance, but if you pay upfront, you may be able to
Get the money back from your insurance.

To “reimburse” is to pay someone back for something that they paid for that you were supposed to.

Like, if my job needs someone to buy more paper for the printer ASAP, I can go to the store, pay for it with my credit card, and then give the receipt to the company. Then the company will reimburse me, by paying me the money for what I spent on the printer, so it’s like the company paid for it all along.

What this means if that you would have to pay for the therapist, then your insurance would give you the money to either fully cover the cost, or partially, depending on their policies. Health insurance companies often have lists of doctors that they have deals with and are prepared to paid for, but some allow you to use doctors who aren’t on their lists, but you will have to send them the bill and they’d pay you back.

So usually when your service provider is “covered” by your insurance or “in-network” the provider can just charge your insurance directly so you don’t need to pay anything directly.
However, in order to be “trusted” by your insurance there’s a whole lot of vetting and blah blah, hence the “network” – they’ve already vetted each other and have agreements.

Reimbursement just means that you have to pay out of pocket first but your insurance will pay you back once they have ensured that Dr. Therapist is indeed a licensed therapist and not a proxy for you using the money to buy Magic The Gathering cards or xbox live credits or whatever. i.e. they pay you back once they determine the service provided was legit. But it depends, you have to ensure that your insurance will reimburse you first, otherwise you’ll pay out of pocket then not get your money back.

The easiest way to find a therapist covered by your insurance is to contact your insurance agency or log on to the insurance website and find a provider. That way you are not aimlessly calling therapists. If you don’t have anyone right where you live, there might be teletherapy services that your insurance covers. Out of network coverage rarely covers the full cost of appointments (minus copay). You could submit paperwork to get reimbursed a portion, but that is likely going to be a pain.

Reimbursement means getting paid back by somebody for an expense. In your case, you’d pay for the therapist out of pocket, then ask the insurance provider to reimburse you for the portion they cover. This would differ from a therapist billing and receiving payment directly from the insurance provider.

The other place where reimbursement is a common thing is with corporate expenses, like business travel. One pays for a flight or meal with their credit card, then submits receipts to their company who reimburses those costs.

Side idea: call the number on the back, tell them your situation and they’ll likely help you find a few names.