How It Works

At Access to Coverage, we make securing insurance coverage for your out-of-network therapist simple and straightforward. Our team works directly with your insurance provider to negotiate a special agreement, ensuring your therapist is treated as in-network, which minimizes your out-of-pocket costs.

Here's how we do it:

Step 1: Contact Us

Start by reaching out to us at 848-525-0066 or email us at [email protected]. We’ll guide you through the process and answer any questions you may have.

Step 2: Complete the Forms

Click on the Begin Process button to fill out two essential forms:

HIPAA Release Form: This form authorizes Access to Coverage to contact your insurance company on your behalf. It will ask for basic information, including:

  • Your insurance company details
  • Policy number
  • Group number (or a photo of the front and back of your insurance card)
  • Your name, address, date of birth, and Social Security number
  • Contract Agreement: This outlines the agreement between you and Access to Coverage for our services.
Once we have this information, we’ll reach out to your insurance company to confirm that mental health coverage is available and begin working to secure in-network coverage for your out-of-network therapist.

Step 3: Information from Your Therapist

We’ll also need some details from your therapist to move forward. These include:

  • Provider’s name
  • NPI number
  • Tax ID number
  • License number
  • Diagnosis codes
  • CPT billing code
  • Length of time in treatment
  • Provider servicing address
  • Provider’s phone number and email address
  • Charge per session
  • Number of visits being requested
Once we have your therapist’s information, we’ll send the forms to them via email. Your therapist will confirm the details and answer additional questions that will help us advocate for your coverage with the insurance company.

Step 4: We Begin Negotiations

With all the necessary information from you and your therapist, we will begin negotiating with your insurance company. Our team will work directly with your insurer to secure a special agreement that treats your therapist as in-network, significantly reducing your out-of-pocket expenses.

Step 5: Coverage Confirmation

Once negotiations are complete, we’ll confirm your coverage. We’ll inform you of the number of therapy sessions covered under your insurance plan and the amount your insurer will pay per session. Your therapist will be officially considered in-network.

Step 6: Ongoing Support

Ongoing Support Our job doesn’t end once coverage is confirmed. We provide ongoing support to ensure everything runs smoothly. If you have any questions or encounter any issues during the process, we’re here to assist you.

At Access to Coverage,

we help individuals get approval from their insurance companies to continue seeing their preferred out-of-network providers while paying in-network rates. Many people face challenges when their provider is not covered by their plan, and we work to bridge that gap by negotiating directly with insurers on their behalf.

The Approval Process

Initial Consultation

We assess your insurance plan and provider details to determine eligibility.

HIPAA Authorization

You sign a form allowing us to communicate with your insurance company on your behalf.

Submission of Request

We compile the necessary documentation, including letters of medical necessity, treatment history, and provider credentials.

Negotiation with Insurance

We advocate for approval by demonstrating why your provider is the best or only suitable option.

Decision & Follow-Up

If approved, your provider will be reimbursed at in-network rates. If denied, we explore appeal options.

How Different Insurance Plans Affect Approval

Not all insurance plans handle out-of-network coverage the same way. Understanding your plan type can help set expectations:

PPO Plans

These typically offer the most flexibility for exceptions.

HMO Plans

Generally require referrals and do not cover out-of-network providers, making exceptions harder to obtain.

Employer-Based Plans

Some employer-sponsored plans have additional flexibility, depending on their agreements with insurers.

Employer-Based Plans

Some employer-sponsored plans have additional flexibility, depending on their agreements with insurers.

Medicaid Plans

Most Medicaid programs do not allow exceptions, though certain circumstances may warrant a review.

What Affects the Chances of Approval?

Plan-Specific Policies

Each insurance company has different rules regarding when they will cover an out-of-network provider.

At Access to Coverage

we handle the complexities of this process so you can focus on your care. Contact us today to find out how we can help.