Choosing An Insurance Plan
When choosing your insurance plan, be sure to ask the following questions:
- How much should I expect to pay for each visit?
- Is my provider covered under the insurance plan?
- Is there coverage if I go to the student health center fortreatment?
- Does my plan cover treatment for substance abuse?
- Does my plan cover me in case of attempted suicide?
- Does my plan cover pre-existing conditions?
In addition to these questions, some insurance plans include limits on mental health coverage. For this reason, it’simportant to be aware of these limits before seeking treatment–or preferably, before purchasing your insuranceplan. Common insurance limitations include:
- Mental health conditions are not covered if treatment issought at the student health center.
- There is a maximum number of visits that are covered peryear.
- Your insurance plan may only cover a percentage of the costof the visit.
- Your plan may only cover M.D.s and D.O.s and notcounselors/therapists/social workers.
- Your plan may have exclusions on suicide and/or substanceabuse.
- Mental health benefits may have caps, which means that theplan will only cover a certain amount for inpatient or outpatient.
Additionally, some mental health professionals do not take insurance, so check to see what the insurance plan willpay for out of network providers. Other factors to keep in mind include:
Does Insurance Cover Couples Counseling
If youre planning on using insurance to pay for couples counseling, the rule requiring a mental health diagnosis will continue to apply and require that one partner receive a mental health disorder diagnosis. Some people feel this has the potential to skew their therapeutic experience.
As with any diagnosis you receive, a mental health disorder diagnosis may remain in your permanent record. In some instances, it may be accessed by background checking systems for your entire life.
Since insurers offer an array of plans, its not possible to give the specifics of each plan they cover. Here are some examples of coverage you may be able to get for therapy from specific insurers:
What You Should Do If You Dont Have Coverage
If your insurance plan does not offer coverage for therapy or mental health treatments there are many other affordable options you can choose that do not require health insurance. Below are a few options you can look into if you are in need of mental health treatments.
- Community Treatment Centers If you are looking for a low-cost or even free option, make sure to contact your local community centers or therapists. Many offer low-cost individual sessions or group sessions that can be free of charge.
- Private-Pay Counseling Many therapists offer payment plans that are based on out-of-pocket costs, but you can create your own treatment plan based on the number of visits and length of visits. On average an individual 45-minute session averages around $160. Contact your local therapists or mental health clinics for a consultation.
- U.S. Department of Veteran Affairs If you are an eligible veteran, many local veteran affair offices will have resources and clinics that offer low-cost or free options for therapy. These are offered to veterans as a benefit regardless of their health insurance plans. To learn more visit: www.va.gov/health.
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Waiting Period Exemption For Higher Benefits
If you are on a hospital policy which provides restricted benefits for psychiatric care, then to access higher benefits you usually upgrade and complete a two month waiting period.
However, from 1 April 2018, you can upgrade without having to serve this waiting period to access higher benefits for psychiatric care in a private hospital.
This exemption applies only once per lifetime and can only be accessed if you have already completed an initial two months of membership on any level of hospital cover.
For more information about accessing the exemption, please contact your health fund.
Using Insurance For Therapy Comes With Strings Attached
Many people dont realize that there are real, long-term costs when using insurance to pay for therapy. Unfortunately, we dont get this information when we sign up for our plans.
Its not like this is top-secret. Its in the public domain. You can Google it. When you read whats up, its no wonder insurance companies and employers dont highlight it in your benefits package.
Fewer therapists are taking insurance. Among therapists who still accept insurance, more are letting patients know about the risks of using health insurance to pay for therapy.
This isnt a scare tactic. Its part of informed consent.
If youre going to use insurance to pay for therapy, you should know the risks.
Once you learn what these risks are, you have to ask,is using my insurance worth it?
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Private Hospital Insurance For Psychiatric Services And Rehabilitation
To be covered as a private patient for psychiatric treatment or drug and alcohol rehabilitation, you can purchase a private hospital policy. Private hospital insurance covers the cost of hospital accommodation and a portion of the medical fees.
A hospital admission may be for an extended period but it can also be overnight or for a day admission only .
Unlike other pre-existing conditions, which normally require you to complete 12 months of membership before you can be covered for a hospital admission, psychiatric services and rehabilitation only require a 2 month waiting period, even if the condition is pre-existing. This means you can be covered 2 months after commencing a policy.
In some cases, you may be able to obtain an exemption from this waiting period. See below for further information.
Restrictions and Exclusions
As not all hospital policies will give you full cover for psychiatric services and rehabilitation, take care to select a policy that does not restrict these services. If you purchase a policy that restricts psychiatric services, then you will not be covered for all or most of the cost of hospital treatment as a private patient. If you arent covered for these services on your current policy and do require hospital treatment, then you can upgrade your policy and complete the 2 month waiting period to be covered.
Going to hospital
Some of the out-of-pocket expenses you may incur include:
The Affordable Care Act And Therapy
Since the Affordable Care Act took effect, all federal marketplace insurance plans are required to offer some sort of coverage for therapy and mental health treatments. The Affordable Care Act enacted mental health parity which treats mental health care as effectively as any physical health care would be. In other words, federal marketplace insurance plans cannot raise costs for therapy any higher than they would for physical health practices. The exact details about your coverage would depend on the plan you have chosen.
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Gratuitous Diagnosis Is A Federal Crime
If you accept insurance reimbursement, you have signed a legally-binding contract. Know if your insurance panel offerings include Z-codes, and if not, dont seek out a diagnosis to tag a client with for reimbursement sake alone.
Defrauding insurance companies is a federal crime. Providing proper diagnosis to guide treatment is a professional ethical requirement. This point has been addressed in every mental health discipline and by every professional organization:
Diagnose properly, carefully, or not at all. Delivering diagnoses to simply receive insurance reimbursement is a legal and ethical violation. Dont do it.
What About If I Need To Make A Claim On My Insurance
Once youve taken out an insurance policy, you may find yourself in a position where you have to make a claim.
An insurance claim is when you ask your insurer to pay the cost of a loss or event that is covered in the policy that you took out with them.
Sometimes, insurers may reject insurance claims, or refuse to pay the full amount. There can be various reasons for this. It can be really worrying and frustrating to have a claim refused, especially if you feel that the decision is unfair.
For more information on why your claim might be refused and what you can do next see the MoneyHelper and Citizens Advice websites, and our tips on what you can do if an insurer rejects your application or claim.
For help understanding your legal rights when making a claim, see our information on your rights when dealing with insurers.
It’s a good idea to keep evidence about your dealings with insurance companies, in case you want to make a complaint or take legal action in future. This could include:
- Copies of letters and emails that you send the insurer, and that they send you
- A record of any phone conversations you have with the insurer
- Any other information that supports your claim
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Can You Direct Bill My Insurer
We cannot check if your plan covers a particular insurance provider. Only the insurance provider holder can find out what types of therapists they are covered for.
Most of our clinicians can direct bill Alberta Blue Cross, Alberta School Employee Benefit Plan and Green Shield.
Some of our clinicians can direct bill Medavie Blue Cross and Criterion Group . These insurers give approved psychologists and mental health therapists an internet portal to use, so we can do the invoicing and provide you with a receipt at the end of the session.
Some of our clinicians can direct bill for clients with Treaty Status who are covered by Indigenous Services Canada Health Benefits. Firefly Counselling may also direct bill for individuals who have attended a Residential School listed in the 2006 Indian Residential Schools Settlement, the client’s spouse or partner, or those raised in the household of a former Indian Residential School student, or any relation who has experienced the effects of inter-generational trauma associated with a family member’s time as an Indian Residential School.
Some of our clinicians can also direct bill other insurance providers such as Great West Life, Chambers of Commerce Group Insurance Plan, CIMUP, Desjardins, First Canadian, GroupHEALTH, GroupSource, Industrial Alliance Insurance and Financial Services , Johnson Group, Manion, Maximum Benefit,
What Do My Insurance Benefits Cover
What is covered varies from plan to plan. Plan coverage tends to be broken into two areas Dental Plans, and Extended Health Benefits. Extended Health plans may cover a wide range of items, but are generally designed to offer coverage for services not included in universal health care . These services are typically grouped into sections such as: prescription drugs, hospital room upgrades, specialized nursing, out of country medical care, artificial limbs/prostheses/medical appliances, wheel chairs/walkers, vision care, and Paramedical Services. Each of these sections tends to have separate application process and funding amounts. This means that if you use up all of your vision coverage to get a new pair of glasses this does not impact funding available for a hospital room upgrade or a wheelchair.
Services such as psychologist/mental heath therapist, chiropractors, physiotherapists, massage, podiatrists, osteopaths and optometrists fall under Paramedical Services. Paramedical Services often draw on one pool of money. This means that if you use your benefits to see an osteopath, you will have less money remaining for psychology services, or to see a physiotherapist.
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What Are Some Common Therapeutic Approaches
Emphasizes learning to recognize and change negative thought patterns and behaviours, improving how feelings and worries are handled, and breaking the cycle of dysfunctional habitual behaviours. It aims to help people see the connection between how they think, what they tell themselves, and the feelings and actions that follow.
Emphasizes identifying and understanding self-defeating patterns in relationships, figuring out why a particular situation is happening in a particular context, changing patterns that dont work and developing healthier ones. In this approach, relationships and the here-and-now are the focus.
Look at problems in the context of other people and social relationships, and focus on understanding and shifting the current dynamics of relationships, families, and even work settings.
May also be integrated into therapy and are becoming increasingly common. Mindfulness refers to developing the ability to connect to the present moment rather than dwelling on regrets about the past or worries about the future. Connecting to the present allows us to create new and healthier ways to respond to lifes challenges.
What Mental Health Conditions Does Blue Cross Blue Shield Cover
Mental health conditions Blue Cross Blue Shield covers may include:
Note that therapists are required to assign you a diagnosis for the above conditions, as well as share the diagnosis with your health insurer, if you are using insurance benefits to pay for therapy.
If you dont want your insurance company to have access to this information about your mental health, consider out-of-network options instead.
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How Insurance Coverage Works
- Even though your therapist takes your insurance plan, you may have to pay for each session out-of-pocket until your health plans reach a certain balance before insurance will pay. That’s why many people prefer to pay for more affordable licensed online therapy.
Sliding Scale Coverage
- Some people find a therapist they like who doesn’t take their insurance, but who will work with them and see them on a sliding scale. Sliding-scale therapists may charge a lower fee than another psychologist who has a private practice, allowing you to bypass the deductible problem. The sliding scale offers lower rates to those with less financial flexibility.
Low-Cost Clinic Coverage
- Another option for finding affordable mental health care is to find a low-cost clinic. Under the Affordable Care Act, some mental health care facilities are designed for people who have lower incomes . There are also universities that have programs where graduate students are training in psychology under the American Psychological Association guidelines, and provide low-cost services under the Affordable Care Act.
What Kind Of Insurance Plan Do You Have
Most insurance plans either have a co-pay or deductible. A co-pay means you pay a set amount for each appointment, and your insurance covers the rest. A deductible plan means that you pay all your medical expenses up to a certain amount, at which time insurance starts covering a specific percent of your costs.
If your plan has a deductible, you will want to know how much each session will cost you before your insurance coverage starts. Most therapists post information about their rates on their website, but your insurance plan might have a negotiated rate with in-network providers. This means that your rate per session is discounted.
Options available to you depend on which company is your health insurer. Companies vary on what plans they offer and what services they cover. Since many people are insured through their employer, you might not get to choose which insurance company covers you and your family. Still, if you own your own business or purchase privately, you want to research your options before committing to a plan.
The cost of therapy varies significantly, with many providers in the United States charging between $65 to $200 per session. The cost depends on your location, the therapist’s training, and any specialized care you might need.
Usually, your insurance card lists which type of plan you have, but you can get this information from their website or by calling the customer service phone number on your card.
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Is Therapy Medically Necessary
For insurance coverage, not all therapy is deemed medically necessary. The same goes for mental health services in general. For example, dealing with stress at work or struggling to cope after moving to a new city might not warrant health-insurance-covered therapy. However, if an assessment rules out a mental health disorder, the parity law says therapy should be covered.
Still, this doesnt mean you need a formal diagnosis before you can seek therapy.
For insurance purposes, therapists can use a diagnostic code for depression, panic disorder, or anxiety. This provisional diagnosis can help get you into your first visit with insurance coverage. But, these diagnostic codes can change in future visits.
Q: Does Medicare Cover Mental Health Or Substance Use Disorder Services
Answer: Yes, Medicare covers a wide range of mental health services.
Medicare Part A covers inpatient mental health care services you get in a hospital. Part A covers your room, meals, nursing care, and other related services and supplies.
Medicare Part B helps cover mental health services that you would generally get outside of a hospital, including visits with a psychiatrist or other doctor, visits with a clinical psychologist or clinical social worker, and lab tests ordered by your doctor.
Medicare Part D helps cover drugs you may need to treat a mental health condition. Each Part D plan has its own list of covered drugs, known as formulary. Learn more about which plans cover various drugs.
If you get your Medicare benefits through a Medicare Advantage Plan or other Medicare health plan, check your plans membership materials or call the plan for details about how to get your mental health benefits.
If you get your Medicare benefits through traditional Medicare and want more information, visit Medicare and Your Mental Health Benefits . To see if a particular test, item or service is covered, please visit the Medicare Coverage Database.
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Ask The Therapist If They Accept Your Insurance
Therapists and other providers often change the insurance plans theyre willing to accept and may have opted out of your plan.
First, you cant be penalized for having a pre-existing condition or prior diagnosis of any type of mental illness. For that reason, you should be entitled to mental health services from day one of your plans start date.
Things that might affect when insurance coverage kicks in:
- After prior authorization. Some services may require pre-authorization before you can obtain coverage for them.
- After meeting a deductible. You may also have to meet an out-of-pocket deductible before your plan starts to cover therapy. Based on the type of plan you have, this amount may be significant.
- After spending a minimum. In some instances, your plan may require that you pay a specified dollar amount on medical services before your coverage for therapy can start.
Some mental health services that may be covered by insurance include:
- psychiatric emergency services
- co-occurring medical and behavioral health conditions, such as coexisting addiction and depression. This is often referred to as a dual diagnosis.
- medical detox services, including medications
Insurers only cover treatments that are considered medically necessary.