I think we’re all aware that there is a mental health crisis in this country. As a result, it can be REALLY difficult to find a therapist who has availability, much less a therapist with availability who is in your health insurance network. Are you stuck paying out-of-pocket for the entire amount? Maybe not!
In the past couple months, I helped a client with her network gap exception request as well as advised a friend how to request one. In both cases, these exception requests were approved.
So, what does this mean and how do you get your request approved?
Suppose you have a child with anxiety who needs to be seen by a mental health provider. You request a list of in-network providers from your insurer. You call each provider who is located within a reasonable distance and are told that none of them have any availability for new patients… or perhaps they are taking new patients but only self-pay patients. Your child needs help, so you end up finding someone who will see your child and you pay 100% out-of-pocket.
Now, you should be thinking: I’m going to call my insurer and request a network gap exception!
Call the customer service number on the back of your health insurance card. Tell the representative that you’d like to request a network gap exception. This is the information that you’ll need before you make that call:
What happens if you are approved?
While, I am focusing on mental health providers here, you can request network gap exceptions for any type of provider.
As always, any time you call a health insurance company, take notes and ask for the representative’s name and a reference number for the call.
Good luck with your network gap exception request!
Bottom line: It never hurts to ask!
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