You’ve made the decision to schedule a counseling session. You make the call. The next pressing question on your mind is, “Do you take my insurance?” and “Will my insurance cover this?” These are good questions. The interesting answer is that just as each individual is unique, similarly, insurance plans are generalizable but quite unique as well. Let’s take “Joe's Insurance,” for example. Two different people may both have Joe's insurance, but they may have different copays, deductibles, and coinsurances based on their insurance plans. And I’ve lost you right there. Once those fancy terms come out, people tend to get anxious or their eyes glaze over entirely, or they simply smile politely, but you know they’ve totally tuned you out.
What does that mean?
Let’s try to unpack these terms so they’re not so scary. In very basic terms, the copay is a set amount that you’ll be required to pay at every office visit. Copays may or may not count towards your deductible.Nerd Wallet explains that the deductible is an amount that you are responsible for before insurance will start paying; this varies per person and plan. Coinsurance is a percentage that you and your insurance are responsible for, which usually applies after the deductible has been met. That’s just insurance in a general nutshell. When we’re dealing with mental health coverage, we have extra issues to contend with such as “carve outs.” This is when the main insurance provider, such as “Joe's Insurance” uses another provider for the mental health coverage, such as “Sally's Coverage.” Most people are not even aware that their insurance has a separate carrier for mental health coverage. Some insurances have coverage for medical but do not even have mental health benefits.
And the answer is...
So back to your original questions: “Do you take my insurance?” and “Will my insurance cover this?” As part of the paperwork process, some of the information needed is the insurance provider, your member ID, group number, date of birth, and address. These are important pieces in verifying benefits. Even at this point, the provider’s office is not always able to access information from the insurance company in the same way that you are. Sometimes we are only able to see that your mental health coverage is “active,” but that’s it. Ultimately, as inconvenient as it is to be on hold for lengthy periods of time, it is the best and safest option for you to double check with your insurance company yourself to avoid any surprises. Now there are also online options that circumvent the long phone wait times and still obtain the necessary information regarding benefits; however, sometimes the phone call is the unavoidable option to obtain specifics regarding copay, deductible, and coinsurance.
What if I'm not covered?
So what happens if we aren’t in-network with your insurance or if your insurance doesn’t cover a specific service, such as family or couples counseling? There are options. We can bill your insurance for out-of-network coverage. You would pay your session fees up front, and depending on your plan, you may be reimbursed a certain amount or it may count toward your deductible. Or we can provide you with a superbill to submit to your insurance for potential reimbursement. You are always welcome to pay your session fees yourself, without having to go through the hassle of insurance. There may be other good reasons to self-pay as well, as we will cover in next week's blog.
You’re never “stuck” based on your insurance. You have choices. Session rates might sometimes seem like a barrier, but your mental health is important, and we are constantly making choices on how we prioritize our finances. Investing in yourself and your mental health is well worth the cost both in the present and the future benefits it will provide. We are always open to conversations about how we can help.
So while figuring out insurance may leave you feeling quite anxious and in need of a therapy session, know that you have options, you’re not stuck, and you’re certainly not alone. We may not be able to answer all of your questions, but we will help you figure out the next steps needed to make the process (hopefully!) a little smoother so that you can focus on the things that are important to you.
We offer a 15 minute consultation at no charge for new clients. You can take advantage of this to determine if therapy and this therapist are right for you before you jump through the insurance hoops. You are also more than welcome to contact me, Joy, directly at 717-746-8750 with questions.