It is increasingly common that small specialty medical and therapy practices are “private pay only”. This can be frustrating and disheartening if you can’t afford the full cost of private pay services, but the only professionals who specialize in your needs don’t take your insurance.
Good news: even when a practice is “private pay only”, services are typically eligible for insurance coverage. This works a little differently than “in-network” services. It can require a little more paperwork on your part as the patient, but it can be well worth it to ensure you’re able to access treatment with a provider who is a good fit for you.
This post will review how “out-of-network” insurance coverage works, and how to go about getting payment from your insurance company for specialty services.
In this post:
- What do "private pay only" and "out-of-network" mean?
- How are claims submitted?
- Is out-of-network coverage the same as in-network coverage?
- What does "allowed amount" mean?
- Summary: how to get out-of-network/private pay services reimbursed by insurance
- Additional resources, including free downloadable guides for calling your insurance