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Saul Marquez, Host at Outcomes Rocket Podcast

Getting Coverage for Out-of-Network Care

Tuesday March 31st 2020

Getting Coverage for Out-of-Network Care


The High Price of Healthcare

How much have you spent on out-of-network services in 2019? While there are many advantages to sticking with in-network services, there are times when it can’t be helped. Perhaps you must choose an out-of-network provider because it’s an emergency, you require specialized care, you’re out-of-town and need service immediately or the only care available is from an out-of-service provider. These are just a few of the many reasons why you may require out-of-network healthcare.


Out-of-Network Provider Reimbursement

Receiving healthcare from an out-of-network provider is one thing. Getting reimbursed for your out-of-network spending is another. 

One of the common complaints I hear from insured members is how frustrating it can be to process an out-of-network reimbursement, especially when you are already spending thousands of dollars annually to pay for healthcare insurance for you and your family.


U.S. Healthcare Costs

In fact, the U.S. healthcare cost is the highest in the world. According to the National Health Expenditures, in 2017, the cost of US healthcare skyrocketed to $3.5 trillion, or $10,739 per person. In 2018, it increased by 4.6%, reaching $3.6 trillion or $11,172 per person. This growing trend of spending shows no sign of waning down, and estimates say that national health spending is expected to increase at an average of 5.5% per year for 2018-27 and to reach nearly $6.0 trillion by 2027

This means more money is being taken out of people’s paychecks to ensure their health is taken care of. When you do decide to get medical help, you may end up spending thousands of dollars to cover for the treatment. 


Is There a Better Option for Processing Reimbursement Claims?

Is there no better way out of this dilemma?

Bill Brown, CEO of Reimbursify, offers help that will significantly change your life, or at least the way you process reimbursement claims that are out-of-network.


Improving healthcare through an innovative tech-based mobile-interface approach

Advances in technology have paved the way for numerous innovative solutions across all sectors of healthcare. Reimbursify is a clear example of how technology helps improve the lives of patients, providers, and payers. 

In my interview with Bill, he strongly emphasized Reimbursify’s goal, and that is to “enable the 120 million people who have out-of-network health insurance benefits in this country to submit an optimized out-of-network health insurance reimbursement claim from their phone in under a minute.” 

In other words, you can submit a reimbursement claim in less than a minute, and on your phone! That’s convenient at its best. Say goodbye to filling out different forms. Reimbursify streamlines the insurance submission process. 


Reimbursify for Subscribers

If you’re an individual subscriber, all you need to do is visit the app store, search Reimbursify, and download the app for free. When you download the app, your first claim is free. For your subsequent claims, it’ll be a very nominal amount of $2 per claim. Do you have multiple claims? The app will give you the option to buy a 10 pack of claim credits for $14.99.


Reimbursify for Providers

Providers have two choices. You can join as a Provider Pro or a secondary tier.

A provider pro means that as a provider you’ll pay Reimbursify a monthly subscription fee which is currently about $99 a month. The Reimbursify team will then authenticate the practice without the software platform, so you can offer the app to your caseload as a concierge. With this process, you can simply hand over a Reimbursify information card to your patient and inform them to download the app and file your reimbursement claim at no cost. 

According to Bill, they’ve received amazing feedback from different providers. Reimbursify is helping providers grow their practice in two ways — new patient acquisition and client retention. Reimbursify has changed the script of the conversation from “No, I don’t take your insurance” to “I’m not affiliated with any insurance networks. however, I will give you an app and you can use that app to self-file for your reimbursement claim in under a minute.” In Bill’s words, “It has successfully shifted the paradigm from a no to I’m going to give you a solution.”

Reimbursify is helping providers be more solution-oriented, offering opportunities to provide care as opposed to the cut-and-dry ‘No’ answer. This ensures that more patients are provided with the care they need without worrying about out-of-network spending. 

When patients are reimbursed for out-of-network services, they become more engaged in the health process. They book more, and they don’t feel limited by the insurance network. 

A secondary tier, on the other hand, means you can offer Reimbursify to your caseload and your patients get the first five claims for free.


Reimbursify for Employers

This relatively new platform for employers is called Reimbursity Enterprise, and it uses the same platform mechanisms to authenticate a company or department within a company, or division within a company. 

Bill said that they’ve seen a great response to this platform around mental health. “Mental health providers don’t take any insurance. And so, if you’re looking for an in-network solution, only three out of 10 providers in your geography are going to take insurance and only a fraction of that are going to take your insurance. So, what we’re communicating to companies is that if you give Reimbursify Enterprise to your employees, you suddenly open up access to 100 percent of all mental health practitioners within their local geography.”

According to a 2017 study published by JAMA Psychiatry, only 55% of psychiatrists take insurance. This fact makes it more challenging for patients who are seeking mental and behavioral services. Unfortunately, we still have better coverage for physical illness than for mental health services. Many insured Americans are still spending more out of pocket on mental health services, despite having a law that requires coverage of services for mental health, behavioral health, and substance-use disorders to be comparable to physical health coverage.


Why do Mental Health Providers Receive Lower Reimbursements?

One reason could be because professionals in the mental health services receive lower insurance reimbursements compared to their other medical counterparts. A study published by the psychiatry online dot org website revealed that psychiatrists receive lower insurance reimbursements even as compared with non-psychiatrist medical doctors providing the same services. (

Henry Harbin, a former CEO of Magellan Health, said that “because of low reimbursement rates professionals in the mental health and substance abuse fields are not willing to contract with insurers.” This results in insurance plans with limited behavioral health networks that may not include therapists suitable for the patient’s needs. 


Access More Mental Health Practitioners

With Reimbursify, you gain access to more mental health practitioners in your area. You’re no longer limited to the narrow list of mental or behavioral practitioners. 

One of the things that got me really excited in my conversation with Bill is learning that you can do Reimbursify in retrospect and for acupuncture. I’m looking forward to receiving some checks in the future. 

Whether you’re a patient, a provider, or an employer, you’ll find great value in Reimbursify. If you’re a provider, it will help create more value for your service. If you’re an employer, you’ll be helping your employees have better health. And if you’re a subscriber, you can focus more on taking care of health now that you know you can count on Reimbursify to help you with your out-of-network reimbursements.

To listen to my interview with Bill, visit this link:

For more inspiring and thought-provoking conversations, visit

Written By

Saul Marquez

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