Using Health Insurance for Mental Health Treatment
Are you thinking about using health insurance to cover counseling? Therapy is an investment in yourself and health insurance can be an incredible asset if you would like to make regular mental health care more attainable.
It is a good idea to learn all you can before you use health insurance to cover counseling. I encourage you to explore all of your options so you can make an informed decision before you use your healthcare benefits.
A Note on Telehealth and Online Counseling
You may see that I am in network with your insurance provider, which is great! Before we get started, I will call your insurance provider to be sure that my services will also be covered for telehealth/online counseling. Every plan is different and some major insurance providers want to redirect clients to their automated platforms when they can. This saves the insurance companies money, but it may limit your choices in who you choose as a therapist. It is always a very good idea to call your insurance provider before your first session and at the beginning of each new year when your plan renews. This helps cut down on any unwanted surprises and helps insure smooth coverage for services.
The Required Diagnosis
Insurance companies have processes in place to make sure customers use their services for legitimate conditions. For that reason, insurance companies require that therapists diagnose their clients during the first visit. This means that your counselor MUST diagnose you with a condition before your insurance will even consider covering the cost of therapy.
Sometimes people would rather their health insurance company not know so much about their lives. Often, your insurance company will require treatment plans, personal information, and progress reports before they decide what to cover. Sometimes, they may request this information after you have been in therapy for some time.
In other cases, clients are concerned that any diagnosis may become labeled as a “pre-existing condition” down the road.
Now, here’s the good news. In 2010, the Affordable Care Act was passed in the US. That act stopped insurance companies from denying coverage based on pre-existing conditions. For instance, if you were diagnosed with depression in the past, your insurance company cannot deny you coverage for depression today (or tomorrow… or ever). You will likely be covered for continuing treatment.
Keep in mind that each policy is unique, and it is a good idea to call your insurance company yourself before any medical or mental health visit to be sure that they will pay for your treatment. As with any health practitioner, doctor visit, dental visit, etc., if your healthcare claim is denied, you will still be responsible for the cost of treatment.
You do have several options. You can use your health insurance for counseling, or you can explore other choices like cash payment, sliding-scale options, or a tax-free health savings account.
Know Your Coverage and Know Your Rights
The very best plan is to contact your insurance company before any treatment and make sure you are approved, and ask any questions that you might think of.
Remember, you always have choices. You can decide to start or stop using insurance coverage at any point in your treatment, as long as you communicate your wishes ahead of time. You may be able to apply for sliding-scale treatment costs, pre-paid visits at a discount, use pre-tax dollars, or work out a plan that better fits your budget.
The Bottom Line is This:
Insurance can be confusing. If you are under stress right now, you may not have the bandwidth to process all of these options alone. It’s a great idea to discuss your possibilites with another person.
I’m happy to talk with you about your options so you can make the very best decision for you and your life. If you do choose to use an insurance plan that I am under network with, I will call the insurance company before your first visit to verify your eligibility and copay. I encourage each client to also call their insurance company to learn more and have any questions answered.