Jan-20-2010

The Nuts and Bolts: Using Your Insurance for Mental Health Services

 

Bolts

When new patients call me, one of their first questions is often “Can I use my insurance?” Thanks to the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act by Congress in 2008, many of us are able to use our health insurance to pay for psychological services.

But figuring out how to access your benefits, and then understanding what your benefits actually mean can be a complicated process. Below I have listed some basic steps and information about how to begin.

First, look at the back side of your insurance card and look for a phone number for “Behavioral Health.”   If there is not one, look for “Customer Service.”  I encourage my patients to call this number before their first appointment and inquire about “outpatient mental health benefits.”  On that call they should learn more than they ever wanted to about their health plan, including:

  •  Pre-authorizations: Some plans require either the patient or the provider to answer several questions about the proposed treatment, and will then authorize payment for psychotherapy sessions.  Sometimes insurance companies dole out sessions 5 or 10 at a time, others authorize sessions for a full year.  It is important to have these authorizations secured BEFORE treatment starts in order to avoid denial of coverage.  Because sessions can get expensive, I encourage patients to ask about authorizations several times, i.e. “So, I just want to make sure that I DO NOT need an authorization before I see Dr. Smith?” just to make sure everyone is on the same page.
  •  Deductible: Some plans require patients to pay a certain amount out of pocket before their benefits kick in. It is important to know several things about deductibles: 1) If you have one 2) How much is it? 3) What is applied to the deductible? 4) When does it re-set? (some re-set on January 1st, others at the start of your employer’s fiscal year, etc).
  •  Co-Pay: Most plans require a co-payment or co-insurance that is payable to the provider at the time of service.  Sometimes this amount is set (i.e., $15) other times it is a percentage of the provider’s fee.  This might be another question to ask your insurance company several times just to make sure you know what you’re in for financially.
  •  Number of Sessions Per Year: Most plans cap the number sessions for psychological services.  This number is important to keep in mind when planning frequency of sessions with your psychologist.  Tip: make sure someone (presumably you or your provider) is keeping track of the number of sessions you use as the year goes on; un-reimbursed session fees can add up quickly.

Lastly, I encourage my patients to look out for the Explanation of Benefits (EOB’s) they get in the mail about our sessions.  If you’re not sure what these are, they come from your insurance company and say “THIS IS NOT A BILL” at the top.  I think it is crucial to be an informed consumer and customer of both my, and the insurance company’s services, and checking out the EOB’s is a great way to do that.

For more information about the next step – finding a great psychologist to meet with – click here.  Good luck!

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3 Responses to “The Nuts and Bolts: Using Your Insurance for Mental Health Services”

  1. Dr Stephanie Smith   January 21, 2010 at 2:34 pm

    Dr Forest
    I am so glad this was helpful! Insurance is so confusing – and everytime I think I have it figured out, they change something on me! Good luck and thanks for reading.

  2. Christine Forest MD   January 20, 2010 at 7:30 pm

    I encouner insurance problems everyday in my psychiatric practice. Thank you for your post. It makes this whole issue much clearer. I will forward it to some of my patients who struggle to understand these issues.