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Out-of-networkWe are out-of-network. Here is what that means for you.
Shift Support Network is a virtual outpatient program for substance use and co-occurring mental health. We are out-of-network with the commercial insurance carriers right now, and credentialing in process. Most commercial plans still include an out-of-network benefit for situations where an in-network option does not fit. We tell you what your plan covers, in plain English, before you commit to care.
What out-of-network means.
In-network means the provider has a contract with your insurance setting an agreed rate. Out-of-network means there is no contract. You can still see the provider, and most commercial plans still pay a share of the bill, but the math is different. We pull your specific plan's numbers and translate them into a real estimate of what you would pay, before you start.
The honest version: if your plan does not have out-of-network benefits, we may not be the right fit. We will tell you that on the benefit check call, before you commit to anything.
Why we have not joined the commercial networks yet.
Shift is a specialty virtual program. Intensive outpatient care, partial hospitalization-intensity hours, and ambulatory withdrawal management for substance use are intensive: small cohorts, licensed clinicians, prescribers, care coordinators, and the federal protections of 42 CFR Part 2 on every clinical record. We are in active credentialing now and will say plainly when a plan is in-network, in process, or still out-of-network.
Outpatient care for substance use is specialty work
Small cohorts, licensed clinicians, family programming, court-ready documentation when there is a legal angle, and 42 CFR Part 2 protections that go beyond standard HIPAA. We have built around that, not around general behavioral health.
We are paneling now
In-network credentialing is in process. That work is ongoing and we will tell you plainly where your specific plan stands when we run your benefits.
We negotiate one-off contracts when it helps you
If your plan's out-of-network benefits are limited, we can request a single case agreement, a one-patient contract that treats us as in-network for your case. We submit this before admission and tell you the outcome in writing.
We verify your benefits and tell you the number
Same-day verification in most cases. We translate the plan into a real, written cost estimate before you commit. No surprise bills.
What happens after you send us your card.
Same-day in most cases. You share the front and back of the insurance card, the patient's date of birth, and the policy holder's information. We do the rest, and we do it before any care is delivered.
We get the answer from the carrier directly
We call the behavioral-health line on the back of your card and pull your specific plan's out-of-network coverage for outpatient and partial hospitalization-intensity care.
We give you the number
We send a written estimate of what you would pay for a typical week of treatment and for a typical episode. Nothing is committed yet. You decide on your timing.
We pursue authorization
Most plans require approval for intensive outpatient and partial hospitalization-intensity care. We submit the clinical for medical-necessity review and handle the review through the program.
You decide
If the numbers and the level of care fit, you admit. If they do not, we help you find a provider whose network status fits your plan. No pressure either way.
If your plan has no out-of-network benefits at all, we will tell you that on this call. We will not admit you and bill knowing the plan will not pay. That is not honest care.
There are still paths forward.
Some plans (many HMOs, narrow-network exchange plans, some Medicaid managed-care plans) do not include an out-of-network behavioral health benefit. For those cases we have two paths and we are upfront about both.
Single case agreement
- We request a one-patient contract from your insurance before admission
- If granted, your in-network terms apply for your treatment
- If denied, we tell you in writing and we do not admit on those benefits
- Most decisions come back within one to two weeks, sometimes faster
Self-pay
- A published self-pay rate for a typical outpatient episode, given in writing before care starts
- Sliding scale available for documented financial hardship
- Payment plans available, interest-free
- No commitment until you decide
If you have commercial insurance, your insurance has rules about what you owe, and we follow them. We do not offer discounts that would conflict with your plan.
Run a same-day benefit check.
Two minutes to share the card and the policy holder's information. We verify your benefits, send you a written estimate, and request a single case agreement if your plan needs it. Nothing is committed until you decide.
Shift Support Network is an outpatient program and is not an emergency service. If you or someone you are with is in immediate danger, call or text 988 or call 911.