Thursday, January 13, 2011

Making Sense of Insurance Benefits and Psychotherapy

Last summer I was looking for a qualified mental health therapist for myself. Yes, even a therapist needs therapeutic support from time to time. There is no shame for me around sharing this. In fact, I feel participating in my own psychotherapy helps me to a better therapist in that it allows me to be aware of my own vulnerabilities and biases, and allows me to be more empathetic to my clients' therapeutic process. After all, I know first hand that it can feel a little odd initially to share highly personal information with someone you really don't know.

At any rate, I decided to use my mental health insurance to access psychotherapy services. I wanted to make sure I could afford to participate in therapy on a regular basis, and I figured my insurance would help make that goal more affordable and realistic.

First of all, when I called the insurance companies as a client, not a Mental Health Provider, I noticed (and perhaps this was my imagination) that they were a little more curt to me than they were when I called as a professional. Shame on you insurance companies - as that does nothing to remove the stigma surrounding accessing mental health services.

Afterwards, deciphering the information I was given was challenging, as I am not an in-network provider for the type of insurance I have for myself. In short, let me say with candor, that the process was a big pain in the 'rear' !

So I wanted to share with you a series of steps that I have developed after my own professional experience and learning from other mental health providers, that you should be prepared to ask your insurance company when accessing your benefits for mental health services.

1. Call the phone number listed on the back of your insurance card under “Mental Health”.

2. Ask the following questions:

  • Does my plan include mental health benefits?
  • Is (Name of Your Therapist) an in-network or out-of-network provider?
  • How many sessions per calendar year does my plan include?
  • When does my plan renew?
  • What is my co-pay amount for a “Specialist” for an Out Patient Therapy Visit?
  • Do I need prior authorization or referral to begin therapy?
  • What is my deductible for mental health services and has it been met?
  • Are there any types of outpatient mental health therapies my plan does not cover?
  • How much does my plan cover for an out-of-network provider?
  • Do I have a higher deductible for out-of-network providers.

All of these questions should help to bring provide some clarity as to the details of your coverage for psychotherapy. Your insurance company and your therapist's billing office will tell you however, that final coverage and benefits will be determined when a claim is submitted. You should know that you will be responsible for any fees that your insurance does not cover. This is why it is important to determine if you have an outstanding deductible.

I hope that helps make sense of things, and remember you can always ask your therapist for help after you've contacted your insurance company. Therapists tend to be pretty nice people after all ;)

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