The right mental health provider, covered like they're in-network.
Whether it's continuity with someone you trust, a provider who shares your language or culture, or expertise your plan doesn't have in-network, Inclara advocates with your insurer for in-network coverage.
Four steps, and we handle three of them.
Tell us about your care
Sign the intake and authorization forms so we can act as your representative. About 10 minutes, done securely online.
We document the gap
We search your plan's provider directory and show, in writing, that no adequate in-network option exists for your specific need.
We build your case
Your therapist supplies a letter of medical necessity; we combine it with your gap documentation into a formal request.
We file and follow up
We submit the request for a network gap exception and push your insurer until it decides. If it's approved, your sessions are reimbursed at your in-network level.
Plans are expected to make exceptions in these situations.
No adequate in-network option
Nobody in your plan's network treats your specific need, speaks your language, shares your background, or has an opening within a reasonable distance or wait.
Continuity of active treatment
You're already in care that's working. Forcing a switch to an unfamiliar in-network provider would set back real progress.
Urgent or high-risk need
Your situation is time-sensitive enough that waiting for an in-network opening isn't a safe or reasonable option.
Each is grounds for a network gap exception, the usual outcome: your plan applies your in-network benefits to the out-of-network provider you actually need. Where a plan insists on a rate contract first, a single case agreement does the same job.
Built for a hard moment, not a sales funnel.
No fee unless we win
We only get paid if your insurer approves the request. If we don't win, you owe us nothing.
We do the paperwork
Network searches, medical necessity letters, formal requests: we handle the parts that eat up your time and energy.
HIPAA-compliant, always
Every document and conversation is handled under strict privacy safeguards, from intake to the final decision.
Built on real grounds
We argue the specific grounds plans recognize for exceptions: language needs, provider specialty, continuity of care, or network inadequacy.
Tell us about your situation.
This isn't a verdict, just a starting point. We'll review what you share and follow up personally, usually within a couple of business days.
Have an out-of-network client who wants to stay with you?
Refer them to Inclara. We advocate with the insurer so your client can keep seeing you, and you can stay focused on the clinical work. How it works for therapists
You point them our way
Send your client to Inclara, or let us know directly. They sign the intake; you don't have to manage any of the insurance side yourself.
You supply one letter
Once we've built the case, we ask you for a short letter of medical necessity, on a form that takes a few minutes.
You keep the client, at your rate
If the request is approved, your client keeps seeing you at your usual fee and their plan reimburses them at their in-network level. No contract, no rate cut, no billing on your side.
Tell us about a client who might qualify.
No names or health details needed. We'll reply with a link your client can use to start on their own, and later ask you for the letter of medical necessity.
How this actually works, in plain terms
What is a network gap exception?
The usual outcome: your plan applies in-network benefits to the provider you already see.
Read the guide →Writing a gap exception letter
What the request has to prove, what to attach, and why plans turn them down.
Read the guide →What is a single case agreement?
The rate contract, and why it's the exception rather than the rule for private-pay care.
Read the guide →Getting your out-of-network therapist covered
What the request rests on, what it costs you, and what your plan actually reimburses.
Read the guide →A therapist who speaks your language
Language and cultural fit are grounds insurers are required to take seriously.
Read the guide →Reimbursement for out-of-network therapy
Why so many claims pay back little or nothing, and how to be reimbursed at your in-network level instead.
Read the guide →What people ask before starting.
What is a network gap exception?
When your plan doesn't have an adequate in-network provider for your specific need, insurers can be required to cover an out-of-network provider at in-network cost. That's what we request on your behalf.
What if my request is denied?
We tell you plainly and walk you through what's next, including whether it's worth re-filing with more documentation. You still owe us nothing if we don't win.
How does payment work?
Nothing upfront, ever. Our fee only applies if your insurer approves the coverage request, so if we don't win, you don't pay.
Is my information kept private?
Yes. Every form, document, and conversation is handled under HIPAA-compliant safeguards, from intake through the final decision.
Ready to get your provider covered?
It takes about 10 minutes to find out if you qualify.
Check if you qualify