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Do you take my insurance?
everyBody Behavioral Health is a contracted provider with some insurance panels. Look on your card to determine if you have an HMO, EPO, or PPO:
- HMO and EPO plans must use an in-network provider to have your appointments covered. If you chose to go out of network, your plan will not reimburse you.
- PPO plans allow patients to see whomever they want. Your out of pocket cost may be higher if you go out of network.
Sometimes the information on your card is not very clear, particularly with mental health benefits. The best way to learn about your mental health coverage is to call the phone number on the back of your card and ask the following questions:
- Is mental health covered under my medical plan or do I have a carve out company? If you have a carve out company, you may have to call that company for further information. The person with whom you are speaking should provide that information.
- If it is covered, ask about your in-network mental health benefits: Do I have a deductible (the amount that you pay each year before the insurance company begins to pay) to meet and if so, is it combined with medical? How much of it has been met? After I meet my deductible, what is my co-pay or co-insurance (the amount that you pay after your deductible has been met).
- If we are considered out of network, ask about your out of network mental health benefits: Do I have a deductible to meet and if so, is it combined with medical? Is it combined with my in network deductible? How much of it has been met? After I meet my deductible, what is my co-pay or co-insurance.
Please gather this information and write down the answers and someone at everyBody Behavioral Health can help you understand your plan. If you have a PPO, and we are out of your network, we are happy to provide you with a “superbill” which insurance companies use to reimburse you according to your benefit plan. While we are on many insurance plans, we are not on all of them.
Risks of using insurance for therapy:
- Required Diagnosis. Insurance companies only cover services that are “medically necessary” and they determine medically necessary when one has a specific reimbursable diagnosis. This means that providers are required to give you a mental health diagnosis in order for your insurance company to pay for treatment. There are several problems with this. First, if you are seeking therapy for help through a difficult time, learning better coping skills, or for another reason but do not have a mental health diagnosis, insurance will not cover this as they do not believe that it is “medically necessary” even though it may be very helpful to you. Second, it would be unethical and fraudulent for your provider to give you a diagnosis that you don’t have just so that insurance will pay for your treatment. Third, even if you do in fact have a mental health diagnosis, given the current state of affairs regarding insurance in the US, having a psychiatric diagnosis listed on your permanent medical record will become a “pre-existing medical condition” which may impact you receiving health (or life or disability) insurance in the future and/or your insurance rates.
- Treatment dictated by the insurance company rather than the provider. Insurance companies often want to review treatment plans or limit the number of sessions that you may have. Patients with eating disorders often need long-term treatment but insurance companies want to save costs by limiting the amount of sessions that you can have. Your provider may have to then request more sessions and at that time it may become a battle between your provider and the insurance personnel who is working for the insurance company to save costs. The insurance company may ask to review your provider’s private records about your sessions in order to continue paying for sessions. This means, that your confidential records may be read by people who work for the insurance company. Think about that — should the insurance personnel read your personal records and also possibly override your therapists treatment plan for you? Your confidentiality will be compromised when your name, diagnosis, treatment plan, and notes are faxed/mailed to insurance companies and are seen by several people: administrative assistants picking up the fax, insurance processors, therapists who work for the insurance company, etc., etc.
- Long wait times. Often when people finally make the decision to seek help, they don’t want to wait days, weeks, or even months for an appointment. This is particularly and completely unacceptable for patients with eating disorders. Research shows that that length of illness predicts recovery rate; that is, the longer someone suffers, the harder recovery will be. If your priority is to have your insurance cover treatment, you may have to wait to get an appointment, which is not good for both your physical and emotional health.
- Not getting specialized care. Insurance companies often do not have specialists on their panel. Most professionals have been through many years of training and specialists have been through even more training for specialized expertise. If you needed to have surgery, you would not have your primary care (general) doc do the surgery, you’d go to a surgeon. You’d likely not go to just any surgeon, you’d want someone who specializes in the surgery that you need. Given the issues above, many specialists are reluctant to be on insurance panels. Further, unfortunately, many insurance companies often do not reimburse specialists adequately to incentivize them to be on the panel and they take weeks or months to pay the provider, which ultimately may impact the patient’s treatment.