Why Does Therapy Cost So Much, Part 3

Today I continue to talk about why therapy cost so much. This is part 3 of the 4 part series. Today I address using your insurance benefits to cover the cost of therapy.

Perhaps by now you see the value in specialized therapy and wonder if you can use your insurance benefits to pay for treatment.

Technically, yes, you can. I am a qualified and licensed mental health therapist that can legally and ethically bill insurance for mental health treatments received in my office. I want to take a moment and explain to you why only limited insurance is accepted. Then I will explain to you how we can work around this to use your insurance if you have it.

I worked for an insurance company for many years before I started Dr. Steph-Wellness Solutions, PLLC. It was my job to review utilization of mental health benefits. Yes the insurance company closely monitors how much and how often you use your benefits. During this time I had to deny a lot of people treatment. In managed care we work with providers and treatment facilities to save money. You potentially save money, however the insurance company saves even more money. I learned that insurance companies wanted individuals to get treatment in the least amount of time.

The goal was to reduce symptoms, then once symptoms are reduced, insurance no longer wanted to pay for treatment. However as you can imagine you are more complex, dynamic, and interesting than your symptoms. The insurance company does not want to pay for you to get fully well, they want to pay for you to be partially well. Often times treatment had to end abruptly before people were ready or able to move on in their own time. Everyday at my insurance job I spoke to treatment providers on the phone and had to ask them to convince me why the individual needed continued treatment.

Yes this does save money because, unfortunately, there are providers out there that want to take advantage of the system. But that is very, very rare. The majority of providers are good and ethical and want to help people heal. The goal of therapy to not to waste your time and money so most clinicians are providing very good treatment. The insurance company determines when treatment is too long and makes decisions to stop coverage. This does not mean that treatment stops however.

This is where I think most people can use some information on how insurance works.

Insurance agrees to pay to a percentage of treatment costs. This means you get treatment at a discount. This is a good thing. Using your benefits comes at a cost though. The insurance company starts to monitor your use and treatment. They can make a decision where you no longer need treatment and can deny you further coverage. Now you have the problem of being engaged in treatment, not quite well, wanting and needing more, but having to scramble to either figure out life alone, or pay for something you were not prepared to pay for.

The people making the decisions to cover or deny treatment are licensed mental health professionals. I shared my experience and education with you, making me a competent and capable clinician. However the individuals reviewing your case are not specialized. The problem with this is the individuals were making decisions to not cover eating disorder treatment. The individuals reviewing these cases never treated eating disorders, nor had any knowledge on how complex eating disorders can be.

I saw many cases get denied when perhaps continued treatment was needed and often critical. This is really scary. Eating disorders kill and treatment can save a life, yet someone with no knowledge of skills on how to treat eating disorders is deciding if you deserve to get your treatment paid for or not. I don’t know about you, but this makes me angry.

You may not quite agree with me yet, but you deserve help from someone who knows how to help you. If you need a plumber, you search and search for the most qualified, experienced, and highly recommended plumber. This plumber may cost you a bit more, but you know you are going to get quality service.

You trust your house to the best, don’t you also deserve the best when it comes to treating yourself or your loved ones?

This is why we do not accept a lot of insurance. We provide quality services and do not want a third party corporation telling us how and when we can treat someone. But I realize most people pay for insurance and want to use their benefits, and we believe you have the right to do so.

Can I use my insurance benefits? The short answer is yes.

When deciding to use your insurance benefits please keep in mind what was previously mentioned. But here are some other things to consider. We can accept Blue Cross Blue Shield as an in network provider. What this means, is that you can see us and use your benefits to save you money.

If you have Blue Cross Blue Shield you want to call the number on the back of your card. Ask them if you have mental health benefits and if there are any exclusions. In other words, your employer worked with Blue Cross Blue Shield to develop a plan. This is why everyone’s coverage is different. Your employer decided what they want to pay for, and sometimes insurance and employers will not cover certain diagnoses or treatments. I have seen plans not cover family or couple’s counseling, and a lot of times group counseling is not covered. So you want to make sure your benefits will cover your treatment. If they will great. Next ask if there is a session limit and if you have a deductible. Make sure to clarify if the deductible is separate from your medical deductible. Then ask what your co-pay or co-insurance will be per session. Remember, mental health coverage is different than going to your doctor. Sometimes plans will not pay for therapy services until a deductible is met.

Don’t freak out yet, you can still use your benefits.

If you have a plan that will not cover until your deductible is met you still have a couple of options. The first option is to use your Health Saving plan or card – also known as your HSA card.. As health providers we can charge your HSA. HSA is there to help you pay for health services when you have a high deductible plan.

Don’t have an HSA? Don’t worry. Because we are in network with Blue Cross Blue Shield we offer sessions at a discounted rate until your deductible is met. Win/Win!

Let’s say you have met your deductible or your plan will cover mental health services. You will be responsible for paying the co-pay at the time of services, so make sure you call and find out what your responsibility will be.

But what if I have insurance, but not Blue Cross Blue Shield, can you still see me?

Yes! Many insurance plans allow you to have Out of Network services where you can see a provider that is not in network. You can see whoever you want, if you have out of network coverage. In this case the insurance company will save you some money and there is less administrative oversight.

Here is how out of network coverage works. We see you and provide quality service. You pay the full fee at the time of service. We issue you a receipt called a superbill. This form is mailed to your insurance company and if you have out of network coverage – and depending on the benefits – you will possibly receive a check for some of the cost. WIN/WIN! You still save money seeing us.

To use your out of network insurance benefits you want to call your insurance company and ask if you have this option.* If so, ask what portion is reimbursed. You also want to ask the address for where to mail the superbill. (The Superbill can be sent to you electronically through our client portal). Once you have this information we are in business and you are ready to call and schedule you appointment!

*Please note: Not all insurance plans provide out of network benefits and we cannot guarantee you will receive reimbursement.

Check back next week for Part 4 of – Why Does Therapy Cost So Much?