To Use, or Not to Use, Insurance – that is the question!
A recent health care law, known as the mental health parity law, was put in place to ensure health care plans provide equal treatment and payment for both physical and mental health. This law is great news as it reflects the changing tides of our medical community as it begins to embrace a more holistic, mind-body approach to health and well-being. However, even if your insurance does provide coverage for mental health services such as psychotherapy, it is important to educate yourself on not only the advantages but also the disadvantages inherent in utilizing your mental health insurance benefits, as these concerns may not be something your insurance company highlights for you in your benefit package.
Advantages to consider:
- Lower out-of-pocket costs. The main advantage to utilizing insurance is the ability to lower your out-of-pocket costs related to the mental health services provided. It is important to understand your coverage as it might include a deductible that must be met prior to payment of services by the insurance policy as well as a co-insurance requirement in addition to the basic co-pay that you are responsible for paying at the time the service is rendered.
- List of mental health providers. Another advantage of tapping into your insurance for mental health services is that your insurance company can provide you with a list of providers in your area to select from, providing you a place to start the process of identifying a psychotherapist you would like to work with. This list will indicate what type of license the mental health professional holds, such a psychologist, clinical social worker, and/or marriage and family therapist, which can help you to begin to identify their education, experience, and focus of therapy.
Concerns to consider:
- Being given a mental health diagnosis. In order for any health service to be paid for by insurance, it must be determined that the services are appropriate and medically necessary. Insurance companies make this decision based upon the diagnosis. Often times, the reason you seek mental health services may not be deemed medically necessary by the insurance company, thus leading to a denial of your insurance claim where you are left responsible for the payment anyway.
- Level of confidentiality. Not unlike when submitting bills for payment of services in the treatment of physical health issues, mental health bills pass through many hands within the insurance company. In addition, insurance companies conduct regular quality audits, where your medical record may be inspected to ensure proper patient care is being provided. Another instance where your medical record might be requested is when you apply for a life insurance or other similar type of policy, which could impact your eligibility and/or premiums of such policies.
- Number of approved sessions. Depending upon your insurance coverage and diagnosis, the insurance company may authorize a limited number of sessions which may or may not be sufficient to reach your personal healing and growth goals. Therapists have an ethical duty to contact the insurance company to discuss your case and request additional sessions, yet the ultimate decision rests in the hands of the insurance company.
- Psychiatric evaluation. Again, based upon your diagnosis, the insurance company may suggest that you seek a psychiatric evaluation to determine if medications should be prescribed when best practice indicates therapy alone may not reduce symptoms.
Good Faith Estimate Notice:
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.