Supporting Clients Through Insurance Changes: A Guide for Clinicians

The beginning of the year brings unique challenges for therapy clients as deductibles reset and new insurance plans take effect. This period of transition can create anxiety and uncertainty for clients who depend on consistent mental health care.

As providers, you have an opportunity to strengthen therapeutic relationships through proactive, clear communication about insurance changes.

The art of timing and listening

Choosing the right moment to discuss insurance matters is crucial. Consider introducing the topic early in a session to allow adequate time for questions and processing.

For major changes, a dedicated phone call between sessions may be more appropriate, allowing focused attention on insurance concerns without cutting into valuable therapeutic time.

When clients first learn about insurance changes, they often experience a mix of emotions — anxiety, frustration, and worry about losing their therapeutic support. Create space for these reactions by validating their feelings and acknowledging the complexity of insurance systems.

Express your commitment to helping them understand their options and demonstrate that you're partnering with them to find solutions.

Empowering clients through knowledge

Guiding clients to take an active role in understanding their coverage builds confidence and reduces uncertainty. Consider saying something like: "Insurance plans often change from year to year. I recommend calling your insurance company directly to verify your current mental health benefits. Would you like me to provide some specific questions to ask?"

Encourage clients to inquire about mental health service deductibles, coverage percentages, visit limits, and pre-authorization requirements. They should also clearly understand the difference between in-network and out-of-network benefits.

We recommend clients ask the following questions directly to their insurance benefits specialist:

• “What is my deductible for mental health services?”
• “What percentage of my mental health services is covered after the deductible?”
• “Are there any visit limits or pre-authorizations required?”
• “Can you confirm that my current clinician is still in-network?”

Be transparent about what insurance information you can and cannot provide, while offering to help interpret insurance responses, if needed.

Setting clear boundaries when you cannot provide specific answers will allow you to keep the therapeutic relationship intact and avoid giving your client inaccurate information.

Navigating network changes together

If you're no longer in your client's network, address this change directly but compassionately. Explain out-of-network coverage clearly.

Out-of-network (OON) benefits are coverage for mental health services from a provider who is not contracted with the client’s health insurance plan. First and foremost, discuss self-pay options and any sliding scale availability you offer including pro-bono services. This is the least disruptive to the therapeutic relationship; however, it might not be feasible for many clients to pay out of pocket rates.

Then you can provide detailed information about submitting claims. OON care typically requires payment of a deductible, higher copayments, and coinsurance than in-network care. Clients may also be responsible for paying the full amount for services upfront and then submitting a claim for reimbursement.

To file a claim, clients need to fill out paperwork about the care they received and send it to their insurance company. The clinician will usually give the client a document called a superbill to include with the claim.

Share information about community resources for affordable care (if you are unsure where to start, contact your local NAMI chapter) and offer referrals to trusted in-network colleagues when appropriate.

We understand talking to a client about their insurance benefits might seem overwhelming. You might say: "I understand this change may impact our ability to work together. Let's explore your options, including out-of-network benefits, sliding scale fees, or referrals to excellent providers in your network. Together, we can decide on the best option for you. What would be most helpful to discuss first?"

Creating thoughtful transition plans

When continuing care isn't feasible, focus on creating a supportive transition plan. This includes preparing a written treatment summary and offering a warm handoff to new providers.

Schedule transition sessions if possible, and provide resources for managing change. Always leave the door open for future contact while maintaining appropriate professional boundaries.

Being clear and direct will benefit the client best, “It looks like our time together is coming to an end. Over the next few sessions we will focus on creating as smooth a transition as we can for you.”

Following up with care

Maintaining connection during transitions is ethically required by clinicians and it also requires balance.

Send brief, professional check-in messages about insurance verification and document all insurance-related discussions. Provide written summaries of options discussed, while respecting if clients need space to process changes.

A simple follow-up message might read: "I'm checking in to see if you were able to verify your coverage and if you have any questions about next steps. I'm here to help you navigate this transition.”

Caring for yourself during transitions

Insurance changes can be emotionally taxing for clinicians, as well. Prepare yourself for difficult conversations by maintaining clear boundaries while showing support.

Seek consultation when needed and keep detailed documentation of all insurance-related discussions. Remember to practice self-care during these busy transition periods.

This is a great opportunity for you, as the clinician, to practice self-compassion – It’s important to be reminded that you only have control over what you do to help your client during this challenging time.

Looking toward the future

While insurance changes can disrupt therapeutic relationships, they also present opportunities for growth. These transitions allow us to demonstrate our commitment to client care and help clients develop self-advocacy skills.

The process of working through insurance changes together often strengthens the therapeutic alliance through collaborative problem-solving.

Most importantly, remember that your steady presence and clear communication can help transform a potentially disruptive insurance change into a manageable transition.

Consider using a reframing technique such as,“This challenge might seem unmanageable right now, and this gives you a chance to practice advocating for yourself like we’ve discussed in our sessions.” And don’t forget to offer encouragement to your client as well. You might say something like, “You’ve developed many skills during our time together to help you through this. You can do this.”

By combining clinical expertise with insurance literacy, we can help our clients maintain the care they need while navigating complex systems with dignity and support.