Using Health Insurance for Your Therapy
How Does Insurance Work?
Health insurance can be complicated. We promise to do our best to verify your insurance coverage for mental health services and help you understand your insurance benefits. We also believe in the importance of being an informed healthcare consumer. If you’d like to learn more more about what is meant by terms like “co-pay”, “deductible,” and “in-network” we encourage you to watch this great video tutorial.
Using In-Network Insurance
Being “in-network” means that we participate in a health insurance plan’s provider network and have agreed to accept a negotiated rate from your insurance provider. This reduces your out-of-pocket costs for therapy. This also means that we will file claims on your behalf and you will only be responsible for paying what your insurance does not cover. This includes co-pays, co-insurance, and deductibles.
We are considered “in-network” providers for the following health insurance plans:
Aetna
Blue Cross Blue Shield PPO plans
Medicare (select providers)
TRICARE (select providers)
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What is a deductible?
A deductible is a specified amount of money that you must pay for mental health services before your insurance company will pay anything towards your services.
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What is Co-Pay?
A co-pay is a fixed out-of-pocket amount that you pay for covered services. If you have a co-pay for a certain service, odds are you will not owe anything else out-of-pocket. That said, some insurance plans have both a co-insurance and a co-pay. Be aware that your co-pay amount does not count towards your deductible.
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What is Co-Insurance?
Co-insurance refers to cost-sharing where you and your insurance provider split the cost of your healthcare services. Your co-insurance amount will be stated in terms of a percentage (e.g, 20% co-insurance).
Using Out-of-Network Insurance
If we are “out-of-network” with your insurance that means that you will be responsible for paying us directly and will be charged our usual rates for therapy. However, as a courtesy we will be able to submit claims electronically to your insurance provider and you will receive reimbursement directly from your insurance provider for any out-of-network benefits you may have. Out-of-network benefits vary from plan to plan, but most plans have out-of-network benefits so it may be worthwhile to contact your insurance provider to learn more about your benefits.
Please note the following:
- We are unable to verify your out-of-network benefits.
- You are responsible for following up with your insurance provider regarding any claims related issues.
Paying Out-of-Pocket for Your Therapy
We understand that therapy can be expensive and that using insurance benefits can make treatment more affordable and thus more accessible. That said, there are times when paying out-of-pocket may either be necessary or simply preferred.
Privacy
When using health insurance to pay for your therapy we are required to provide certain information to your health insurer. This information includes a psychiatric diagnosis. While we don’t want a diagnosis to be a barrier to treatment, we do understand that participating in therapy or counseling is a private matter and that many people prefer to maintain the utmost privacy. If you decide to pay out-of-pocket for your services you can rest assured that no treatment information will be released to anybody without your consent, unless legally mandated by law (i.e., mandated reporting requirements or when court ordered by a judge).
High Out-of-Network Deductible
If you find that your out-of-network benefits include a high deductible that you don’t think you’ll meet then it might make sense to preserve your privacy and elect to pay out-of-pocket. Paying out-of-pocket will also allow you to purchase therapy session packages (when available) which will allow more flexibility in your treatment options and lower your treatment costs.