Read on for the ins and outs of insurance benefits & tips on finding out what you're entitled to.
Because health insurance is an industry that is constantly changing—both in the private sector and nationally—knowing what mental health benefits you're entitled to can be difficult.
Here are some of the frequently asked questions that we hear from YourTango Expert's clients:
What kind of Experts accept insurance payments?
Counselors, psychologists, social workers and psychologists can accept insurance payments; however that doesn't mean they all do. The ability to accept insurance is offered to most masters or higher-level practitioners, but the choice to accept such payments is an individual decision. Many Experts do not take insurance because of the increased workload. Some opt out of this payment option and accept cash/check payments only. Coaches and marriage educators typically are not legally able to accept insurance payments, but you should ask your Expert specifically what payment options they do accept.
To find out if your Expert accepts insurance, visit their services-offered page and/or send in a free consultation question to ask for details.
I know that I have limited coverage when it comes to mental health care. After I use up my allotted sessions under my plan, what happens?
Generally speaking, typical health plans cover 50 to 70 percent of the cost each session, and offer coverage for 10 to 30 sessions per year. The number of sessions awarded to a client is usually determined by the diagnosis offered by the practitioner. Most insurance carriers have a formula for determining the number of sessions needed to impart sufficient and healing treatment for the given issue.
When seeking insurance benefits it's important to know that your provider will do some form of reporting to your insurance agency about the issue that led to treatment (in a very generic fashion), and what diagnosable condition is being treated. The amount of personal information disclosed is different for each plan. If you're concerned about disclosing personal information, contact your insurance provider prior to seeing your Expert to find out what information they collect. Your Expert will not usually be able to answer this question for you, so talking with your provider is best.
After you have completed your allotted sessions, paying for the remaining sessions, which can run between $75 and $175 depending on location, falls to the client. Some Experts accept fees based on a sliding scale, which goes up and down depending on how much money the client brings in annually. Insurance plans usually require a co-payment for medications that can be as low as $5 for a generic prescription and $10 for a brand-name drug.
Medicare—the federal health insurance program—covers 50 percent of most outpatient care and has no limit on number of visits.
What kinds of issues are covered under an average insurance package?
Coverage depends on your provider, and plans vary widely. Most insurance companies cover anxiety and depression issues, relationship difficulties, death of a spouse, partner or child, addiction and situational life issues (job transitions, retirement etc). When you contact an Expert, ask if your issue will be covered under your insurance plan.
How do I find an Expert that will accept my insurance?
The best place to check is with your insurance provider; they usually have lists of "approved" practitioners in your area, many of which are on YourTango Experts. In general, the three different kinds of plans are:
Health Maintenance Organization (HMO), plan or a prepaid health plan: In order to have the insurance cover your sessions, you must choose an Expert that is part of the network and get a referral from your primary care physician.
Preferred Provider Organization (PPO) plan: In order to have the insurance cover your sessions, you must select from a limited number of providers, you usually do not need a referral from your primary doctor and it is possible to have fees partly covered for providers who are out of network.
Point of Service (POS) plan (also known as a Fee for Service plan): You can see any doctor in the country, and your insurance company will cover your fees.
My employer offers an Employee Assistance Program. What is this?
Employee Assistance Programs help employees resolve personal issues and legal problems. These programs are usually brought into play during crisis situations and are meant to be a short-term fix. The visits are confidential, so the content is not disclosed to your employer, and the programs often lead to some kind of ongoing therapy.
Will my employer find out about my problems if I use my insurance to pay for sessions?
Confidentiality laws protect anything you discuss with your therapist, unless your Expert believes you may harm yourself or others. While your insurance company has access to your diagnosis and appointment dates, this information is not available to your employer.
What if I don't have insurance?
You can still get help. Many YourTango Experts members accept sliding scales for clients in need. Depending on where you live, your state, county or city government may also provide mental health care on a sliding-scale schedule. Fees are often determined based on an assessment of your family size and income. For more information, check with your state or county Department of Health and Human Services. In addition, you can inquire about federal mental health services under Medicare or Medicaid. Although most programs are fairly standardized and coverage is based on a system of reimbursement to providers, coverage varies in each state.