Maximize Your Benefits with Skadi’s Out-of-Network (OON) Services
Navigating insurance benefits for therapy can feel overwhelming, but it doesn’t have to be. Every so often, you can find a mental health therapy practice that takes pride in supporting clients not only by providing mental health therapy, but also through understanding their healthcare coverage. This includes our team at Skadi Sport Psychology.
When a therapist is “in-network,” they have formal agreements with specific insurance companies to provide services under pre-negotiated rates and conditions for mental health treatment. Being Out-of-Network (OON) means we haven't signed those types of agreements with insurance companies. Instead, we choose to operate independently. In other words, we make the rules regarding treatment--not the insurance companies.
Because we understand the inconvenience of being OON and want to make sport psychology as accessible as possible, we do what we can to support clients by offering concierge out of network insurance claims processing. (In other words, if they have Out of Network benefits, they don't have to deal with Superbills. We take care of them!).
Here’s everything you need to know about why we’ve chosen to be OON, how our process works, and how you can make the most of your benefits.
Why Does Skadi Choose OON?
Our decision to remain OON is rooted in our commitment to providing exceptional, client-focused care with as much integrity as possible. Here are a few of our primary reasons:
Tailored Support for Athletes: Each athlete's mental health and performance goals are different. By operating independently of insurance constraints, we can design mental health therapy plans with your goals and your athletic identity as the main priority. We don’t compromise the quality or frequency of sessions due to insurance-imposed restrictions. In other words, we decide on the frequency and focus of your sessions based on your goals—not your insurance company.
High-Quality Focus: OON allows us to maintain a high standard of service, focusing on performance and well-being rather than just mental health symptom reduction. In other words, we can prioritize long-term improvement, performance enhancement, and mental wellness over quick fixes. This is possible because we operate outside the limits of one-size-fits-all insurance plans (which often limit the number of sessions clients can receive based on their level of functioning).
Your Privacy Matters: By keeping all records in-house, we further enhance your confidentiality and data security. This ensures that your performance and mental health journeys aren't shared with others unless you are the one to request it.
Equitable Provider Compensation: It is common in the mental health industry to provide no compensation for interns. Once they graduate and move onto private practice, it's quite common in our industry for providers to receive a % of revenue from their sessions. I (the owner of the practice) have a lot of thoughts here, but I'll be brief: If we want to improve our professional pipeline for the next generation of mental health therapists, we have to pay them. At Skadi, all interns are compensated, and that compensation is not dependent on what insurance companies choose to reimburse us.
Understanding the costs of sports psychology services can help you make informed decisions about your care. For a detailed breakdown of what affects pricing and how to find affordable options, check out our blog post on How Much Does a Sports Psychologist Cost?
How Does Our OON Process Work?
We know that insurance processes can be tricky to understand. (Frankly, we're still figuring some of them out.) We’ve streamlined our insurance process to make it as simple as possible for you to use your out-of-network benefits. Here’s a step-by-step guide to how it works:
1. Insurance Verification
Before your first session, our team will verify your insurance benefits to confirm your OON coverage. We do this by calling your insurance directly and sharing your information with them to verify what's covered (and what's not). This ensures there are no surprises and helps you understand how insurance reimbursement will work.
2. Upfront Payment
On the day of your session, we collect our full session fee via our electronic scheduling system. This keeps the process efficient and all payments coincide with the date of the session so you know exactly what you're paying for.
3. Claim Filing by Skadi
After your session, we handle the insurance claim for you! You won’t have to worry about filing paperwork—we’ll take care of submitting everything to your insurance provider. The session cost will go to your OON deductible. it will be submitted for partial or full reimbursement.
4. Your Insurance Explanation of Benefits
Within a few weeks, you’ll receive an Explanation of Benefits (EOB) from your insurance company (typically in the mail). This document will detail whether your session payment contributed toward your deductible or whether the insurance is reimbursing a portion of the session.
5. Insurance Reimbursements
Most insurance companies mail reimbursement checks directly to you. If they mistakenly send it to us, we apply the amount as a credit to your next session.
This system allows you to focus on your sport psychology sessions with less stress about administrative tasks. Of course, if you have any questions, you're always welcome to email us.
Example of OON Reimbursement
Reimbursement can vary because insurance providers base their payments on an "allowable rate," not the full session fee. Here’s a quick breakdown of how costs may apply:
OON Deductible: $1,000
Deductible Met to Date: $500
→ The client still owes $500 toward their deductible.
Individual Session Fee: $155
Allowable Rate per Session: $100
Coinsurance Rate: 20%
→ With coinsurance, the client is responsible for 20% of the allowable rate ($20 per session).
Insurance Reimbursement Rate: 80%
Result: Client pays $155 up front. Once the client has paid $1000 in Out of Network costs for the year, the insurance company agrees to pay $80 (80% of $100) and sends the client a check for $80 in the mail. Client is thus reimbursed for $80, making the total session fee $75 once deductibles are met.
Three Tips for Navigating Your OON Benefits
Making the most out of your OON benefits can seem overwhelming, but a few simple strategies can streamline the process:
Understand Your Policy
Familiarize yourself with your insurance plan’s OON coverage. This includes your deductible amount, coinsurance rates, and reimbursement processes.
Track Your Sessions and Payments
Maintain a log of your session dates, costs, and insurance communications. This helps you stay organized and ensures smoother reimbursement.
Set Expectations
Reimbursement depends on two factors:
Your deductible amount (how much you’ve paid toward the amount versus how much remains).
The allowable rate set by your insurance plan (not the session fee itself).
Reassurance Amid Insurance Complexity
Decoding insurance policies can feel like a full-time job, which is why we’re here to simplify it for you. By working with an OON provider like Skadi Sport Psychology, you reap the benefits of expert, personalized care while still taking advantage of your insurance coverage. From verifying benefits to filing claims, we’re dedicated to supporting your mental health and athletic performance every step of the way.
If you’re ready to take the next step in performance enhancement or simply have more questions about using OON benefits, we’re happy to help. Schedule your free consult today to ask your questions about the OON process and we'll help you determine whether we'd be a good fit for you.
