Basics Regarding Insurance Coverage When Seeking Private Psychotherapy
Mental Health Insurance: Research Your Policy
If you want or need (or both) financial reimbursement for part of your psychotherapy treatment please research your insurance policy. Insurance coverage is set up in the following way:
Policies define who and what they will cover in terms of mental health. This is not determined by the service provider, but is determined by your insurance company and your particular policy.
Three Main Categories of Policies Related to Mental Health Insurance
Some policies, like PPO policies, cover a certain amount of the mental health provider’s fee when you use a service provider included on the insurance company list of preferred providers. Those policies will also cover services, but to a lesser degree, when a qualified and credentialed service provider is not listed with the insurance company, i.e. an out of network provider.
Some policies, like HMOs, only cover mental health service providers who are signed up with the HMO company.
Other policies are POS (point of service) policies where you can see any mental health provider you choose as long as she or he is qualified, credentialed and offers services for conditions covered by the policy.
My Practice as an Example
For example, I am an independent service provider, a mental health clinician, i.e. I am licensed and have a private psychotherapy practice. I am not listed on any HMO panel. I am not on any PPO preferred provider list.
I am qualified, and I have credentials. I am a fee for service provider. This makes me an out of network provider.
HMO policies will not reimburse for my services.
For patients to get full or substantial insurance reimbursement for the cost of working with me, they need to have POS insurance.
To receive partial reminbursement they need to be signed up with a PPO. Then a certain percentage of my fee will be reimbursed, usually with a maximum amount for each year.
Both POS and PPO policies must specifically cover the conditions for which treatment is sought and the services I offer.
Need for Accurate Mental Health Insurance Coverage Information
I’m posting this information because many people with eating disorders who are looking for treatment ask if the psychotherapist accepts insurance. The question is really, “does the insurance provider accept the mental health clinician?”
Appropriate Questions
Once you research your policy, you will be able to ask a private practice clinician:
Are you a preferred provider with my insurance company?
or
Are you signed up with (on a panel with) my HMO?
If you ask the questions appropriate to your coverage you will have a much better position to look at your money issues and what will be involved for you to receive the treatment you need. You will also have more realistic information regarding your financial situation so you can determine your next step.
Good luck!
Useful insurance information link from Psychology Today:
Ins and Outs of Mental Health Insurance
Bulimia: How to Recognize Triggers for a Binge or Purge Episode and How to Recognize Six Levels of Recovery. (long title for a brief summary)
In eating disorder recovery you explore your triggering situations in stages.
Explore Your Situation
Please pay attention to what is going on in your life, including your internal life, just prior to a binge or purge activity.
When you feel the urge and then need and then out of control compulsion to binge or throw up or do some other ritualized behavior familiar to you and which numbs you out or which you think relaxes you, explore your situation.
Even if you can’t explore in the moment, be ready to look at that moment later.
First Level
First you look at possible triggers after the fact.
You’ve binged and then purged. You are in the familiar aftermath of mess or sorrow or sense of failure. Or perhaps you are relieved and feel ready to take on the next event in your day.
Before you move on into despair or into a numbed automatic functioning machine, look at what was going on for you earlier in the day. Look at what was going on in your mind and emotional world as well as tangibles in your life.
You may notice something that triggered your binge. If you don’t and you give yourself a moment to attend to your situation after every binge purge episode, you may discover patterns. You may discover that certain events or people or feelings always precede an episode, and perhaps they are triggers.
If you attend in this way you give yourself an opportunity to see what events, relationships, activities, thoughts or feelings seem intolerable. These are the triggers that set off eating disorder actions to help you feel relaxed or numb.
With increased strength, growth and more curiosity, you begin to look before the eating disorder actions.
Second Level
Later you can start to restrain yourself from acting out. This is a stressful time full of anxiety and paradoxical thoughts and feelings.
“I want to.” “I won’t.”
“Just one last time.”
“No.” “Yes.”
“Just a little.” “It’s never a little.”
You might feel dizzy, off balance, afraid. Your vision might go into a light strobe action, as if everything were going through a slight shudder. You might feel your gorge rise and fall as if your body were trying to get ahead of the binge purge cycle and just rumble as if you were going to heave.
You succomb. You binge. You go back to Level One.
You may or may not be able to look at what preceded the episode.
Third Level
Same as second level except this time you succeed. The agony is the same. But this time you call for help from an established and trusted resource person to help get you through the experience without acting out.
You may be so relieved that you didn’t act out that your mind shuts down for a while. Or you may get a window into your situation where you see what triggered you in a way you could never see before.
Fourth Level
Same as second level except this time you have more options than calling a particular person as you did in level three.
At level four you feel the binge urge feelings coming on. You have an idea, if only a vague idea, of what is triggering you.
Now you can call a person or go for a walk or read poetry, or wash the dishes or clean your room or closets or do laundry instead of living through another binge purge episode.
The key word is “instead.” You grab hold of your energy along with your awareness of what is triggering you and you use your energy in a constructive way.
At level four you begin to experience more fully the fact that feelings are temporary. Even the enormous and powerful urge to binge and purge is a feeling that will pass.
At level four you discover the wonderful feeling of living through the urge and instead of seeing food wrappers and feeling groggy from the eating disorder binge purge episode you see something positive. The dishes are done. Or the closet is more orderly. Or your mind holds a moving image from a poem you read.
Or simply and profoundly, you don’t see the aftermath of a binge purge in your home or reflected on your face in the mirror. The presence of the absence of the binge or purge episode seems like a miracle.
Fifth Level
With more practice and more recovery you learn to anticipate what can trigger you. You make self-care arrangements for yourself in advance of compelling urges.
Sixth Level
With solid recovery, you use your stable, healthy, integrated self and positive, realistic sense of yourself to get through periods of stress without the aid of eating disorder actions.
Progress, Not Perfection
Do you ever go backwards? Yes.
Is that failure? No.
Going back levels simply means you need more practice, more growth, and more development.
Raising the Stakes
Also, you might not appreciate that you have raised the stakes during your progression toward health. If you remember the fundamental principle behind these levels, i.e. explore your situation, you may find that some situations are more complex and stressful than others.
Anytime you move back a level you probably have encountered a situation that calls upon you to develop more fully.
For example, if a visit to friends for dinner is a triggering event for you and you overcome it, then you might think you are at level four or even five.
But if you then are to attend a family dinner and find yourself unable to stop a binge or purge episode, that doesn’t mean you are failing. It means you have more issues to explore and resolve with your family than you do with your friends. That’s normal and even predictable.
Failure or Progress?
Once you are on the recovery path, an episode is not a failure. An episode serves you. An episode lets you know that imbedded in the triggering situation are some life lessons for you, some issues that need to be understood and resolved, some strength in you that needs to be more developed.
In your recovery process, wherever you are in your progress toward healing, health and development, please remember to pay attention to what is going on in your life – outside and inside, like it or not. This reflection on your experience gives you the opportunity to recognize your eating disorder episode triggers.
Giving yourself respectful attention as you go through your life experiences is key to creating an eating disorder free life. Plus, you can discover what is genuinely meaningful to you and rally your strength and energy to go for what might give you real and sustained joy.
Eating Disorder Symptoms and Effective Eating Disorder Treatment Don’t Have a Straight Line Connection
A Human Journey
Years ago, when my daughter was a girl, she and I sat atop a heavy black rock encrusted knoll in Dartmoor, in Cornwall England on a lovely spring afternoon.
The Territory
The vista before us was Cornwall in its glory. Before us unfolded the moors, forest and hills, meadows, streams and a river, a few tiny villages, pools of glittering water that might have been small lakes.
The Goal
We picked a point in the distance, she what appealed to her and I what appealed to me. Taking turns we discussed how we might reach our goals.
First Quick Plan
“How could you get there?”
Stretching out her arm to follow her gaze, she said, “I’d go over there.”
“But there are no roads. How could you even get down this hill to the other side?
A bird could fly over everything and get there, but how could you?”
Developing Realistic Plan
Pause. Narrowing eyes. Little wheels turning in the skull under that shining long dark hair.
“I’d need a rope and strong shoes to climb down the rocks on this hill. And jeans too. Otherwise the rocks would hurt my knees. (She was wearing shorts.)
“Mmmm,” I replied. “So you would need equipment.”
“Yes.”
Strategy
What followed was a lengthy analytic discussion of what we would need to transverse the magnificent territory before us.
We looked at the details of a river and discussed whether we would have to go miles above to where it was less broad or if we could swim it or build a bridge across it, or maybe use the rope to swing over. Ah, but nothing was there to tie the rope.
We had to evaluate our strength and swimming skills deciding that we couldn’t’ make the final decision until we were closer because we had to take the current into consideration.
Risk Factors
Was it worth the risk of using our resources to get to the river close at hand if we couldn’t cross it and had to trek beyond to find an easier crossing?
We factored beauty into our calculations. Looking at how the river gracefully curved through the forest and meadows we decided that a long walk, even camping along side that river, even though it took us off course for a while, would be worth it.
We could double back on the other side and cross the meadows beyond. Cows? Okay. Ponies? Okay. Sheep? Okay. Bulls? No. We’d have to determine the challenges we would be facing and which we could deal with and which we could not.
Possible Assistance
Maybe we could get help along the way? Possibly. We could check at a village to get a better understanding of our course, maybe get supplies. Maybe even get a guide for part of the way.
What does this warm and lovely memory have to do with eating disorder recovery?
Eating Disorder Recovery Journey - Your Goal
You see your goal. No more eating disorder.
The straight line, as a bird flies, to your goal is to stop all symptoms. Then you are done. You arrive at your destination.
But you are not a bird. And you can’t stop symptoms of an illness through will power.
But you can decide to go for your beautiful goal of health and freedom.
Realistic Appraisal and Strategy
Then comes the evaluation of what you need as you proceed. That has to do with a realistic appraisal of your situation and your resources, who you can rely on, what unpredictable challenges you will meet, what tools and equipment you need to bring with you, how to recognize how to avoid danger as much as possible and how to avail yourself of help along the way.
Symptom End versus Health and Freedom
Descriptions of eating disorder symptoms abound in literature and across the Internet. Many of those symptoms are a danger to health and even life. But no one gets scared into stopping symptoms.
People do get scared into trying to modify symptoms, like only bingeing on healthful foods. But that’s no answer and no way to reach your goal of health and freedom.
Journey to Health
Effective treatment that leads to eating disorder recovery is a journey. You need trusted and competent companions, just one for starters. You need information. You need resources.
You develop resources as you go, like greater understanding and appreciation for what it takes to live in your own skin as you participate in the world. You develop particular skills learned in therapy but also learned in classes and life experiences.
You learn how to evaluate your situation, be considerate and respectful of your feelings. You then reflect on your awareness so you can take steps based on your strengths.
If your strengths are not adequate for a task you have learned how to recognize competent and trustworthy people so you can then ask for help and use that help.
Adventure
The journey to eating disorder recovery, like any adventure, involves fear and discomfort but also involves beauty and joy. The recovery journey involves the abiding pleasure of developing physical, mental and emotional strengths and knowing you can rely on your strengths in this world.
The key to eating disorder recovery is not to focus on how terrible the symptoms are. The key is to focus on the life of freedom and health you want. Then you can advance on your journey to the goals you have chosen based on your mind and your heart.
It’s not a straight-line journey. But it is a grand journey.
Binge Eating Question Based on Ignorance of Nature of Eating Disorders
“Do I have an eating disorder if I only binge on healthy foods?”
Desperate Hope
This question always brings sadness to me. It speaks of a desperate hope to find a way to be safe and healthy. If you are asking this question, then deep down you know that bingeing is dangerous. You know bingeing is wrong for your body and your life.
You want to give yourself good nourishment. You want to take care of yourself. You want to live.
Compulsion to Binge Eat
At the same time you are compelled to binge. You feel helpless to stop. So you continues to binge while attempting to make your binge safe.
Danger of Ignorance
You may try and even succeed for a while in convincing yourself that if you are bingeing on healthy food, then it’s not really a binge.
This belief will only prolong the duration of your eating disorder and prevent your reaching out for help so necessary for recovery to begin.
Lost in Eating Disorder Pain and Suffering: Sometimes I Forget
Dear Readers,
Sometimes I am so happy and deeply involved in the recovery work I share with my clients in my private practice that I momentarily forget the depth and vastness of the pain and suffering lived daily by people entrenched in their eating disorders.
Joy in Recovery Work
The eating disorder recovery path, even though challenging to every aspect of a person’s way of being in the world, is a joyous experience for me. This must be why I do this work. Being with someone who is climbing out of the prison of an eating disorder and blinking from the light of the new world she enters is an incredible joy.
Sharing with her the always unpredictable turns of her life as she heals and develops is a never ending growth experience for me as well as my client. As she brings her healthy and united sense of herself to face the world and follow the genuine lead of her heart and soul I feel privileged and grateful to share in her journey.
In the day to day of my professional world the people I meet who are affected by eating disorders, for the most part are on their healing path. They come to me because they are ready to begin. Or they come to me because they have begun and want to go beyond their current limits.
Suffering
Then I’ll receive a phone call or an e-mail from someone in the depths of their eating disorder who reminds me of all those people who not only suffer, but suffer in ignorance. Ignorance creates a hurdle difficult to leap.
Ignorance
Ignorance itself is an interesting word. It could mean that information is ignored. Or it could mean that information about something isn’t available or accessible.
So, if a person with an eating disorder is ignorant of dangers in her behaviors, is it because she doesn’t know the dangers or is ignoring the dangers? If she is ignoring the dangers, is this a conscious choice or is she ignorant of her ignorance?
I’ll give some examples of dangerous ignorance in my next post.
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