Mental well-being is as vital to a person’s overall well-being as a physical well-being, and such things as therapy are inarguably beneficial for a healthy life. However, costs of therapy often prove to be prohibitive for many persons. Mental health is gradually becoming a topic of discussion community, so it is vital to explain how insurance contributes to the payment of therapy sessions. In this particular article, the author will attempt to illuminate the possibilities existing in insurance and therapies for patients who need help.
Insurance and Therapy Basics
Currently, health insurance is available with individual, families, and group insurance plans. It can in most cases encompass medical bills, hospitalization and surgeries. But the coverage of therapies sessions greatly depends on the insurance company and the type of insurance contract.
I covered the four different costs of therapy. And today I’m gonna be talking a little bit about how insurance coverage works for mental health services, at least here in the United States of America.
Insurance Coverage Overview
In other areas of the world, I’m not entirely sure how it works, because I don’t practice there. Just keep that in mind when you’re watching this video, it might work a little bit different in your area of the world.
Types of Insurance Coverage
So there are three main ways that insurance may be able to cover the financial costs of therapy. These are: in-network coverage, out-of-network coverage, and single case agreements, sometimes referred to as out-of-network exceptions.
About the Author
But first, let me introduce myself. My name is Mallory Grimste and I am a teen therapist. I am here to help you improve your mental health. If that is something that you’re into, make sure that you hit that Subscribe button, and turn on the bell notification. That way you’re notified every single time I post a new video.
Getting Started with Therapy
If you are looking for help or support, getting started with mental health therapy, for whatever situation you’re dealing with, you might wanna share this video with your parents, if they’re concerned about financial costs or investment, or how to start therapy. Like we talked about in last week’s video, one of the main costs of therapy is financial. Which is where insurance can potentially help out.
Types of Insurance Policies
There are several types of insurance policies available, including:
Individual Health Insurance: ¼Mezban health insurance covers medical expenses of an individual or one person at a given time.
Family Health Insurance: Ensures that the family receives medical expenses cover for the entire family.
Group Health Insurance: Is an insurance product designed to provide for a group of people’s medical bills, often employees of a company.
Critical Illness Insurance: Includes emergencies necessary expenses associated with devastating diseases like cancer, heart disease, etc.
Does Insurance Cover Therapy?
The answer to this question is not a simple yes or no. Insurance coverage for therapy sessions depends on several factors, including:
Insurance Provider: Of course, there are differences in insurance policies of different insurance companies on the therapies coverage issue.
Policy Type: It is up to your insurer, depending on whether you have an individual or group policy, to determine what your therapies will cost.
Therapy Type: The kind of therapy you are going for like the CBT or the Psychodynamic therapy may be reimbursed differently.
Mental Health Condition: The coverage policy of whatever specific mental health condition you are being treated for like major depression or general anxiety disorder may be distinct.
Insurance Providers
Some insurance providers that offer coverage for sessions include:
Adamjee Insurance: Provides for outpatient sessions.
Jubilee Insurance: Includes treatment carried out as inpatient as well as outpatient.
EFU Life: Covers therapy sessions as one of the benefits of health insurance.
How You Can Determine if Your Insurance Provider Covers Therapy
If you’re unsure whether your insurance policy covers therapy sessions, follow these steps:
Understanding Insurance Coverage
So real quick, before we dig into this, I need to just point out that I am not an insurance expert. The best person to talk about when it comes to seeing how your insurance can potentially cover the financial aspects of paying for therapy is your insurance provider themselves. And that’s because each person’s insurance provider, and plan under that insurance provider, may look a little bit different, because it’s catered to you or your family’s needs.
Mental Health Parity
In the United States of America, we do have what’s called the mental health parity. Which means that legally speaking, at the time of this video, insurance providers must provide equal or similar coverage for benefits, of mental health, behavioral, or substance use conditions, as they do for other health conditions. So just a quick note that equal coverage does not equal good coverage. It just means comparable or similar.
In-Network Coverage
In-network coverage is typically the most easy to understand, because it’s the most widely used use of your health insurance coverage for health services. So what this means is that when somebody is considered in-network with your insurance plan, they have a written contract with the insurance provider, that they will accept the rate that the insurance will pay them in exchange for their members being able to access services with that provider.
How In-Network Coverage Works
So that means, say for example, you have ABC insurance. Yes, I’m making up a health insurance, because insurance plans are all different, and I don’t want you to mistake the example for an actual insurance provider. ABC insurance, you go to their website, or you go to a provider’s website, and you look and see, do they accept ABC insurance as direct payment? If they do, that means that they are in-network. And so you would just follow whatever coverage plan your insurance says that they cover for in-network services. So this may mean meeting the deductible. May mean paying a copay. It may mean something completely different, check with your insurance provider directly.
Out-of-Network Coverage
Now, many mental health therapists actually prefer to work on what’s called an out-of-network basis. So out-of-network means that they are still licensed, able to provide the services that your insurance may or may not cover. But it would be under what’s called an out-of-network coverage benefit. That means that that provider does not have a contract with that insurance. So you would pay for the services upfront, and then seek reimbursement from your insurance provider out of your out-of-network coverage benefits.
Understanding Out-of-Network Benefits
If you have the letters PPO or POS on your insurance card, you more likely than not have out-of-network benefits. If you’re not sure if you have out-of-network coverage, or what that looks like for mental health services, I want you to call member services on the back of your card. And you wanna ask these three questions. Question number one. Do I have out of-network benefits or coverage on my plan for behavioral or mental health services? Now some insurances classify mental health therapy under behavioral health.
Out-of-Pocket Expenses
Even if your insurance policy covers sessions, you may still incur out-of-pocket expenses, such as:
Deductibles: The dollars you have to spend yourself before your chosen insurance plan begins to pay.
Co-Payments: This is the cost made for a single therapy session.
Co-Insurance: The ratio of amount you will have to contribute towards the total cost of the session. You can contact us here.
Single Case Agreements
And then the third question, this requires a little research. If you already have a mental health diagnosis you want to have that actual diagnosis, and preferably the DSM-5 code that goes along with it, so that your insurance provider can look up specifically for that diagnosis what they are willing to cover and not cover.
If you have a specific provider in mind that you’re looking for reimbursement coverage for out-of-network benefits, you also wanna ask that provider, what are the codes that they use to bill for services rendered? Now these are not the same from discipline to discipline, and they’re not always the same even therapist to therapist.
So as an LCSW, or licensed clinical social worker, I have certain diagnostic codes for similar services provided that a psychologist would use. But the number code that I use as an LCSW would be different than a psychologist would use. Now, I don’t know why they get so nuanced with the different insurance coverages, but they do,
(chuckles) so make sure that you are referencing the right codes when you are asking for what your insurance provider specifically reimburses for. And if you happen to know the session rates for those codes, even better, because then you can get exact numbers. (sighs) That was a doozy. (chuckles)
Single Case Agreements (Continued)
So the third option is a little more complicated, and that is called a single case agreement, or sometimes referred to as an out-of-network exception. So there may be extreme circumstances where if you don’t have out-of-network coverage, or the out-of-pocket cost is so extreme to access the services that you so desperately need,
your insurance may be willing to enter into what’s called a single case agreement with you or the provider. So what this means, is that even though the plan that you have previously signed up for with your insurance provider dictates that you may or may not have certain coverage options. If you are needing to see somebody who is highly specialized or trained,
or you’re having difficulty locating an in-network provider. Or their in-network providers do not work with your population, or specific issue, you may be eligible for requesting a single case agreement to work with your preferred provider. And this is not a guarantee. It often requires a clinical letter of support. Which means that you may need to take a risk, complete a client assessment, to obtain a diagnosis and that letter before you can start working with that provider.
Example of Single Case Agreement
For example, I happen to be one of few therapists in this area in Connecticut where I currently practice that runs group therapies for teenagers. Because of that, if somebody cannot find another provider to provide that level of care and support, and it’s deemed medically necessary for them to engage in that level of treatment and care, then they may be eligible for pursuing that single case agreement. Ultimately though, your insurance provider gets to decide whether they want to engage in that level of support with you or not.
Conclusion
Session insurance exists but for this it is better to know more about your insurance policy and its features. From policy document, talking to the insurance provider, stating whether it needs pre-authorization, you can come to know if your policy covers it. A particular attention should be paid to such additional costs as deductible, co-payment, and co-insurance. Do not let the price of having a therapist turn you away from getting professional help – check through your insurance and begin the journey of change.
If you are feeling depressed and you’re looking for ways to ask your parents for help and tell them that you’re feeling depressed, I highly recommend that you watch the video on your screen right here, where I’m talking all about how to get that support from them. And if you found this information in this video useful and helpful, please be sure to share it, you never know who you could be helping in the process.
Additional Resources
Psychological Association: An organization which gives general knowledge about mental health and therapies.
Insurance Association of: A professional body which acts as an affiliate to the insurance sector in .
Mental Health Helpline: A support service that callers can call to get mental health help.
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