How to find a psychiatrist or therapist who takes your insurance

In network and out of network, in plain terms

A practice is in network when it has a contract with your insurance plan. You pay the plan's agreed rate, usually a copay or coinsurance after any deductible, and the practice bills the insurer for you.

Out of network means there is no contract. Some plans still pay part of the cost, usually less, and you may pay the practice in full and file for reimbursement yourself. Some plans, often HMO-style plans, pay nothing out of network except in emergencies. Your plan documents say which kind you have.

One insurer can sell many plans, and a practice can be in network for some and not others. "We take Blue Cross" is not the same as "we are in network with your plan". It is also worth checking that the plan covers the kind of visit you need, since evaluations, medication management and therapy are billed as different services.

Read your card before you call anyone

Your insurance card holds most of what a practice will ask for. Some plans hand mental health care to a separate company, and the card may show a separate behavioral health phone number. If it does, that is the number to call about therapy and psychiatry.

• The plan name, exactly as printed, and your member ID.
• Whether the plan needs a referral from primary care before you see a specialist.
• Your copay or coinsurance for specialist or office visits, and your deductible.
• Whether telehealth visits are covered the same way as in-person visits.

If you have Medicaid

Many state Medicaid programs work through managed care plans, which means your coverage runs through a specific health plan with its own network. In Tennessee the program is TennCare. A practice that accepts one Medicaid plan does not necessarily accept the others, so give the practice the plan name on your card, not only the word Medicaid.

Your plan's member services line can tell you which practices near you are in its network and whether they are accepting new patients. Ask them to check, not just to read you a list.

Medicaid coverage also has to be renewed periodically. If you receive a renewal notice, respond by the deadline; a lapse in coverage can mean a practice cannot see you under your plan until it is restored.

If you have Medicare

Medicare.gov states that Part B covers outpatient mental health care from psychiatrists, clinical psychologists, nurse practitioners, clinical social workers, marriage and family therapists, mental health counselors and other professionals. That covers most of the people who work in an outpatient psychiatry practice.

With Original Medicare, ask whether the clinician accepts Medicare; some providers do not participate. With a Medicare Advantage plan, networks work much like private insurance, so ask whether the practice is in network with your specific Advantage plan.

Exactly what to ask

Ask the practice first, then confirm with your insurer. Write down the date, who you spoke to and any reference number. If a bill later does not match what you were told, those notes are what you will need to dispute it.

• To the practice: "Are you in network with [plan name exactly as on the card]?"
• To the practice: "Is the clinician I would see credentialed with that plan, not just the practice?"
• To the practice: "What do you expect a new-patient visit to cost me, and a follow-up?"
• To the insurer: "Is [practice and clinician name] in network for outpatient mental health on my plan?"
• To the insurer: "Do I need a referral or prior authorization for this visit?"
• To the insurer: "What will I owe toward my deductible, and what is my copay after that?"

Using the insurance information in this directory

The insurance names shown on a practice's page here come from the practice. Use them to narrow your list, not as confirmation. Plans join and leave networks, and a listed insurer may not include your particular plan. The reverse is also true: if a practice you like does not list your insurer, a short call to ask is still worth making.

A practical approach: open your state page, shortlist two or three practices that list your insurer and offer the care you need, then make the calls above. That usually takes less time than calling down a long, unfiltered list.

If nobody in network has an opening

Call your plan's member services and say plainly that you cannot find an in-network provider with availability. Ask them to help you locate one, and ask whether the plan makes exceptions when no in-network option is available within a reasonable distance or time. Plans handle this differently, so ask rather than assume.

Telehealth can widen your options, since any licensed clinician in your state may be able to see you. You can also ask out-of-network practices about self-pay rates or a sliding scale, and ask your plan what it would reimburse.