Requesting out-of-network coverage (New Jersey)
I recently began coverage with AmeriHealth NJ (via private coverage) after a bout of unemployment and starting a new job that is unable to provide me with health insurance yet.
To keep this as brief as possible, I have been suffering from severe depression/suicidal ideation for over a decade. Over the course of many years, I have been to therapy and psychiatrists, etc. and nothing seems to be helping. After extensive research, I managed to find a treatment option (a trauma-based specialized therapist) that is exactly what I am looking for. Having had extremely ineffective experiences with therapy before, I had a very specific criteria and this guy is the only therapist in New Jersey who meets this (we had a preliminary phone conversation, as well as one session, that allowed me to verify this). The only problem is that he charges $175 a session and is out-of-network. I work both full and part time and my income is nowhere near high enough to cover this expense.
I went to the AmeriHealth website and found the link about requesting out-of-network coverage. It took me to a page on the State of New Jersey website where I could file a consumer complaint about my insurance.
I guess I have two questions here. First, is this the correct avenue that I am supposed to be taking in order to request out-of-network coverage?
Second, if so, what type of specific language should I be using in my complaint in order to (as much as possible) guarantee its approval? Are there certain words, phrases, or anecdotes that I should include? Is there anything that I should outright avoid saying?
I am very new to this process but am at an extremely critical point in both my physical and mental health where this provider seems to be my last resort. I appreciate any help.