A provider directory can tell you who takes your insurance. What it doesn’t capture is how a clinician will respond when a traditional approach doesn’t work for your child. 

Experience adapting an evaluation, understanding different ways of communicating or looking beyond significant behavior to understand what may be driving it isn’t something you’ll find in a search filter. 

“Two clinicians can have similar credentials and very different experience,” said Dr. Courtney Cotter, senior director of behavioral health at Aspire Living & Learning. “Our team works with children and young adults with a wide range of developmental and behavioral needs, including people who communicate in different ways or have significant behavioral challenges. That experience helps us recognize when we need to adjust our approach to better understand and support the child in front of us.” 

Why Clinical Experience Matters 

The experience you want in a clinician may depend on what brings you through the door. You may be looking for an evaluation to better understand your child’s behavior, communication, attention, learning, or development. Or your child may already have a diagnosis, and you’re looking for therapy with someone who has experience with their particular needs. 

That experience can be especially important when a child’s communication, behavior or developmental needs mean a traditional approach doesn’t work as intended. A child who communicates with few or no spoken words, for example, may understand much more than they can demonstrate through a test that relies heavily on verbal responses. A child who has difficulty sitting at a table, following unfamiliar directions or engaging with a new person may need a clinician to adjust how an evaluation is approached.  

“A test score is one piece of information. You have to understand the child in front of you and what may be influencing how they’re able to participate,” Dr. Cotter said. “If a child can’t respond in the way a test expects, we don’t want to make assumptions about what they understand or are capable of. We need to ask whether there is another way to approach it that gives us better information.” 

That same thinking carries into therapy. Significant behavior doesn’t happen in isolation. A clinician may need to consider what a child is communicating through their behavior, along with sensory needs, emotional regulation, their environment, and other factors that could be contributing. 

“Experience gives you more places to look,” Dr. Cotter said. “If something isn’t working, you don’t immediately assume the child can’t do it or isn’t participating. You ask what you might need to change about the way you’re approaching them.” 

When you talk with a clinician, share what you’re seeing and ask about their experience with children who have similar needs. If you’re seeking an evaluation, ask what they do when traditional testing doesn’t work well or doesn’t seem to reflect what your child understands. If you’re looking for therapy, ask how they adapt their approach when something isn’t working. 

Understanding Out-of-Network Behavioral Health Benefits 

You may find a clinician with the experience you’re looking for only to discover they don’t participate with your insurance. 

If they don’t participate with your insurance, don’t assume that means you have to choose between paying the full cost yourself or finding someone else. Some health plans include out-of-network behavioral health benefits that may reimburse you for a portion of therapy, an evaluation or another eligible service. 

Call the number on the back of your insurance card and ask whether you have out-of-network benefits for the specific service you’re considering. Find out whether you have a deductible, how reimbursement is calculated, whether you need prior authorization, and what you’ll need to submit for reimbursement. 

“You can say exactly what you’re trying to do,” Dr. Cotter said. “‘I’m looking for a psychological evaluation for my child, and the provider I’m considering is out of network. Do I have benefits for that?’ You don’t have to speak insurance. Ask them to explain your coverage in a way you understand.” 

If your plan does offer out-of-network benefits, a superbill may help you use them. A superbill is a detailed receipt from the provider that includes the information your insurance company needs to review the service. You pay the provider directly and submit the superbill to your insurance company to request reimbursement. 

How much you receive, if anything, depends on your plan. Some plans don’t offer out-of-network benefits, and others have deductibles or reimburse only a portion of the cost. A superbill doesn’tguarantee reimbursement. 

But if you’ve found a clinician with experience that feels particularly relevant to your child’s needs, it’s worth finding out what your plan allows before you rule them out. 

“If you find someone with experience that seems relevant to your child, don’t let ‘out of network’ be the end of the conversation,” Dr. Cotter said. “Ask what your plan covers. You may still decide that provider isn’t an option for your family, but at least you’ll be making that decision with the information you need.”