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
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3 Responses to “Basics Regarding Insurance Coverage When Seeking Private Psychotherapy”
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From my last employer I was able to get 80% of my therapy fees refunded. I had a ppo plan with blue cross blue shield. The therapist was an “out of network” one. The reason i chose them was because their therapy practice specialized in eating disorders. This is why I think my therapy was very effective and helped me progress in my recovery. I’m no longer in therapy. However I would also advice everyone to check with their insurance provider about therapy coverage.
Andrew Bolis
http://howtostopeating.com
Andrew Bolis’s last blog post..Stop Binge Eating the Easy Way - 3 Tips
Hello,
I am a psychiatry resident training in Boston, MA. I used to live in Chicago for most of my life and trained their for medical school before moving out here to Boston. I have noticed that both in Chicago and Boston, even at major academic/hospital institutions, there is definitely a lack of eating disorders training. Over the past decade, eating disorders units/clinics/centers at these academic hospitals have shut down due to being “money losing” units, and as a result, pracitioners/educators in these fields have left as well to pursue private practice or move to other centers. I’m not sure how the situation is in LA where you are practicing. But, I find it somewhat disappointing that even at major institutions, psychiatry residents get a lack of training in the area of eating disorders. With the co-morbidity of eating disorders being so high with other psychiatric illness, I feel this is an area that can’t be ignored. Often times, we stabilize patients, and discharge them, and “hope” they hook up with the psychiatris/psychologist/counselor that can help them though there are very few with vast experience in the field. I have been asking many people, and wanted your thoughts, on how you feel that our healthcare system psychiatry/psychology, medicine in general needs to be altered to better address this area of need. I think some of it is obviously a lack of funding. But, from your experience, do you think that not enough is done in the transition from inpatient to outpatient, emphasis is placed on the wrong part of therapy, etc? Sorry if this is too broad of a question. I’m just trying to gather various perspectives. Thanks.
Andrew’s last blog post..Psych Wars!
Thank you for your post and your question.
I receive many calls from people who are fresh out of an inpatient eating disorder recovery experience and who are looking for a psychotherapist to continue their work. Often they don’t have quality help from the inpatient program in finding a solid referral for continuing outpatient treatment.
Your post helps me understand why this is so.
My perspective is limited to my experience here. I am dismayed and sad when I listen to people who were in good programs but who thought the program was the answer. They can feel defeated and are self-critical when they discover that the inpatient program didn’t bring about permanent cure. They feel shame when they call for an appointment.
Also, parents who pay for treatment often lack a solid understanding of what genuine recovery work requires. I believe parents and children - including adult children - are put in a terrible situation when the patient starts on a recovery path and the parents do not appreciate what’s involved.
Sometimes it’s the parents who believe the inpatient program will do the trick. They believe that their child will emerge from such a program well and will not need more treatment. Or the parents believe the patient will need only short term supportive work to maintain her newly found recovery.
Parents will then assume that the cost of treatment will drop or end. A patient’s stress increases when she gathers more strength to deal with her next level of challenge in her therapy. If parents see her increased strength as an indication of recovery they think that therapy sessions can be decreased or stopped.
If this happens, the patient’s movement toward health not only stops, but her gains are undone. Parents are bewildered by what they consider a relapse.
Just at the moment when the patient is prepared for doing some deep and sensitive work, her attention needs to convince her parents to continue to pay for therapy and stop asking questions like, “When will you be able to cut back?” or making statements like, “You are so much better. We’ve decided that you don’t need so much therapy now.”
Well meaning parents who believe they are supportive can actually harm their children’s progress by not understanding that when eating disorder behavior stops the deep recovery work is just beginning.
You ask about placing emphasis on the wrong or right part of therapy. Over the course of my 25 years in this field I have seen a number of psychiatric residents as patients. They are, without exception, astounded to discover that genuine affection and caring is not only part of the professional relationship but is essential for eating disorder recovery.
Today the recent work in the field of neuroscience and attachment theory is showing that attachment issues (translation in lay terms -ability to give and receive sustained, reliable, sensitive and aware love) are critical in the development of a human being from birth and are critical in the development and healing of a human being in psychotherapy.
See the work and writings of Allan Score, PhD, and professor at UCLA,
Hippocrates knew that caring for patients meant actually caring about them.
Somehow that original teaching needs to be brought back to our healthcare system.
An end to eating disorder behaviors is the bare beginning of deep recovery. Once those symptoms stop the underlying emotional needs and developmental deficits come to the fore and need to be addressed with knowledge, sensitivity and genuine caring.
People cannot recover from eating disorders without love.
Thanks for asking!
Best regards,
Joanna