|
Questions and Answers about Mental Health Benefits:
|
| Q:
Does my health insurance cover psychotherapy services? |
A:
Most health insurance polices cover mental health services under
guidelines that refer to "medically necessary" services. This typically
means coverage for face-to-face sessions in an office for a diagnosable
mental health problem. The amount of coverage varies according to
your policy. In addition, a managed care company that specializes
in mental health benefits may provide the actual coverage. These
"carve-outs" mean you must check to find out who provides your coverage
and what the benefits really are. |
| Q:
How do I find out this information? |
A:
There is usually a toll free number on the back of your insurance
card. Call and obtain the information about your actual coverage. |
| Q:
Can I see anyone I choose? |
A:
Most plans significantly limit your selection of mental health providers.
You must make sure the person you have chosen to see is definitely
covered by your plan. Some plans allow you to see anyone but you
pay a higher deductible and higher co-pay for that option. |
| Q:
Do I need pre-authorization for office visits? |
A:
HMOs generally require pre-authorization, which you can obtain initially
by calling the toll free number. Once the original authorization
has been used, the therapist is required to submit a form explaining
why more sessions are needed. This typically requires sharing some
confidential information about your problems and describing the
plan for resolving those problems. Preferred Provider Organizations
(PPOs) may or may not require pre-authorizations. You will need
to check. |
| Q:
Are there advantages to paying out-of pocket? |
A:
Despite the higher cost to you, there are advantages to paying for
your own therapy. Confidentiality is a key reason. Providing the
information insurance companies require means data is entered into
a national data bank and the information is handled by various insurance
company employees. Also, some insurers attempt to have a more active
say in treatment plans. Finally, if you are paying than you can
see whomever you want and at whatever frequency you and your therapist
decide is in your best interest. |
| Q:
What services are not covered? |
A:
Again this may vary according to your plan but typically such services
as court testimony, school visits, telephone and email consultations,
and collaboration with other professionals are not covered. In addition,
certain specialized services (e.g., hypnotherapy, biofeedback) may
not be covered. |
| Q:
What is the most important issue for me to keep in mind about insurance
coverage? |
A:
That it is YOUR responsibility, not the therapist's, to confirm
the nature and extent of your coverage. While most therapists are
able to be helpful with this process, they should not make assumptions
about your coverage or take the responsibility to confirm the coverage.
Also, keep in mind that you do not automatically receive the full
coverage offered in your policy. This only occurs if the insurance
company approves requests to use all of your benefits. One final
note. As the subscriber you have the power to appeal decisions if
requests for services are rejected. You also have the power to inform
your employer and/or the insurer if you are dissatisfied with your
mental health coverage. |
