Is your psychotherapy covered by your health insurance? Here’s how to find out:

Before you contact a psychotherapist, find out whether your health insurance covers psychotherapy, and if so, what does it cover?Many people imagine that their insurance will cover their psychotherapy. After all, it’s a medical expense, right? And, they assume that their therapist is network and will file paperwork. Depending on where you live and who you choose to see this is often not the case.In many major cities, many – particularly more experienced – psychologists, psychoanalysts and other psychotherapists practice out-of-network.  This means, you pay out-of-pocket, and you submit your bills to see whether you can recover any money from your insurance company and, if so, how much?Unless money is no object prior to calling a psychologist or a psychotherapist, it’s a good idea to call your insurance company and find out whether your insurance benefit covers you. Here are the steps that you should take:

  1. prior to calling your insurance company, you need to know what your diagnosis is. Of course, this is impossible because in order to have a diagnosis, you need to see a psychotherapist.  However, for the purpose of finding information, pick a DSM-V, diagnosis.  For example, you might choose anxiety disorder, the code number is 300.02.  Diagnoses can be found on the web. Remember, this is not actually your diagnosis you are just guessing as a way of getting information about your benefits. Your psychotherapist will provide you with your diagnosis.
  2. Next you need to know your psychotherapist’s zip code. Again, just pick a zip code in the neighborhood where you are likely to find a psychotherapist.
  3. You need to have your psychotherapist’s fee. You will not have this information, yet, but just identify the fee that you anticipate. If you aren’t sure of fees, call psychotherapist who you would like to see and ask them what they charge.
  4. Now, it’s time to call your insurance company. It’s important to allow a lot of time for this call; allow about 1.5 hours. Be prepared to be polite and pleasant during what can, at times, be a frustrating experience.  You may get passed from voicemail to voicemail or you may be disconnected. This is why it’s important to allow a lot of time.
  5. When you reach the health insurance company, tell them that you are seeking mental health care and that you intend to go out-of-network. At first they may tell you that you have a $10. or $30. co-payment. This is almost never true if you are going out of network. If this the answer that they give you, ask them what your in-network benefit is. It’s likely that this is your in-network  benefit.  If they assert that this is your out-of-network benefit, ask them to double check. If they stick with this answer. Thank them, call back and repeat the process.  Most likely, your benefit will be 40 or 50% of what is called the Usual and Customary cost. Unfortunately, this often does not reflect the actual cost.

For example, let’s say that your psychologist charges $250.00 for a 45 minute session.  The insurance company may have decided that the Usual and Customary cost is: $2oo.  This means that if your insurance covers 50% then they will only actually pay $100. because they have capped the cost at $200.  Some insurance companies have accurate appraisals of what psychotherapists in their community actually charge. Others might have very low caps. It’s important to find this out so that you can choose and option that is viable for you.

6.  After you have obtained this information about psychotherapy insurance coverage. Call back and go through the entire process, again.  This is because you want to make certain that the information is correct.

What if your psychotherapy insurance inadequate

If your psychotherapy insurance doesn’t cover much out of network, you have a couple of options:

    1. you can go in-network. If this is your plan, it’s best to call your insurance company and obtain a list of providers in  your area. In a major city where many psychotherapists are out-of-network, calling clinicians and asking if they are in-network is likely to be a frustrating process.
    2. Another alternative to going in-network is to seek out clinics in the area who may offer services at a fee that you can afford. Check out your local psychoanalytic institute as well as other area clinics.
    3. A third option is to seek an evaluation, out-of-network, with the aim of clarifying what sort of therapy, if any, will be most helpful to you. Ask them to refer you to a person, or place, that will meet your needs. Although the cost of this is higher than going in-network, an experienced clinician may be better able to evaluate you and refer you to a skilled clinician who will work with you at a fee that you can manage.

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