Client Sample Insurance Letter for out of Network Consideration

Client Sample Insurance Letter for Out of Network Consideration

Date

Address

Phone number

To Whom It May Concern:

I am writing to request that your insurance company provide out-of-network payment for services at the Attachment Institute of New England, located at 21 Cedar St, Worcester, MA. Although The Attachment Institute is not currently on your provider list, my needs cannot be met through other service providers due to the specific issues related to trauma and adoption (or foster care or guardianship, etc, which ever your situation is)

that my family is facing. (If applicable, outline any unsuccessful treatment experiences and/or whether you are facing the possibility of having your child hospitalized or placed in a residential setting)

The Attachment Institute specializes in the complex issues that are faced by adoptive, foster, guardianship, and other ‘non-traditional’ families. The Attachment Institute offers evaluations, clinical treatment, consultation, advocacy, training, education, and other resources to children with trauma and attachment issues and their families, teachers, and other therapists.

Typically, treatment involves two clinicians for two-hour sessions with child and parent(s). The fee for treatment is $…. per clinician per hour. This is very much in line with other therapy rates and reasonable by today’s standards. Additionally, the clinicians are available by phone and email, and encourage contact between sessions as issues merit. Generally, treatments are complete in fourteen sessions.

Each clinical staff member of The Attachment Institute is independently licensed and has at least a decade of experience working with trauma related attachment issues. The Attachment Institute is not for profit and is a registered agency of the Association for Treatment and Training in the Attachment of Children (ATTACh). ATTACh is an international coalition of professionals and families dedicated to helping those with attachment difficulties by sharing knowledge, talents, treatment modalities and resources.

The Attachment Institute of New England adheres to the ethical guidelines and standards of care set forth and promoted by ATTACh.

Your earnest and careful consideration of this request to help my family is greatly appreciated. The clinicians at the Attachment Institute are available to answer any questions you may have.

Respectfully,

Attachment Institute of New England Phone: phone 508-799-2663

or include a brochure from AINE