Barbara Hunt, MS, LPC, LMFT

THE FUN STUFF - INSURANCE

     Here are the General Things to know about your Insurance Contract.

     Call your insurance company before scheduling an appointment to determine if you need to be pre-certified and if I’m a provider on your plan. Never assume anything.  Insurance companies plans change frequently.  You will use the information on your insurance card to call.

     Your Insurance plan is a contract between you and your insurance company. You have obligations to it and the insurance company has obligations to you.

     It's your money so read this carefully so you can obtain the information you need from your insurance provider about your Specific Contract.

     Not to worry!  It will take you more time to read this page than it will to call your insurance company to ask the things you need to know below.  And, you'll become an educated consumer.

     It's important for you to understand how your insurance works before you begin therapy.  You don't want to have any unwanted surprises after your claim is filed!  It's your responsibility to understand their benefits.

     Because you have a contract that you signed with them, telling them you "didn't know that" after a claim is filed will fall on their deaf ears!  Conversely, because you will now be an educated consumer, should there be a mistake on their part, you'll be able to spot it on the Explanation of Benefits (EOB) statement you receive in the mail or in your online account with them.

     Below are the main things to understand before you call the insurance company.   During the call, you'll need to ask these things and enter the information in the paperwork you'll receive from me.  Accuracy is important as this information is used to file your claim for you.

     If you'd rather eat a nail than call an insurance company, go to their website to read the benefits for your plan.  Make sure you distinguish between the Medical benefits, Mental Health benefits, and any EAP benefits.

1. Mental Health Insurance and Medical Insurance Benefits are Not The Same.  And May Be With Two Different Insurance Companies  

     Mental Health and Medical are two separate benefits and each is structured differently.

     Your Mental Health insurance benefits are usually with the same company that provides your Medical insurance benefits. For example, both might be with Blue Cross.  However, the benefits for each will be different.

     But, with some plans, your Mental Health insurance benefits may be with a different company than that of your Medical insurance benefits. For example, your Medical insurance might be with Blue Cross Blue Shield and your Mental Health insurance might be with Optum.  Look on the back of your insurance card for the telephone number for Mental Health/Behavioral Health and call to determine what your Mental Health benefits are.  Be sure to ask what the name of the company your Mental Health insurance is with and what the name of the company your Medical insurance is with.  That information will go on your paperwork.

2.  Wait!  There's More!

     Yes, there's more!  You may have benefits with 3 different insurance companies. Some Mental Health insurance plans may offer two different types of benefits.  The primary Mental Health benefit typically requires you to pay a copay or co-insurance for your sessions.  A second benefit might be an Employee Assistance Plan, called EAP.  The EAP benefit offers a limited number of sessions with no copay.  These two benefits may also be with two different companies or they may both be with the same company.  Example:  your primary Mental Health benefit might be with Optum, but your EAP benefit may be with Magellan.  So if you have both of these benefits, be sure to ask what the name of the company is for each when you call.  Get the correct spelling if it's a weird name and write it down.

3. Do You Have An EAP Benefit?

     If your plan includes an EAP benefit that you want to use before using the primary Mental Health benefit, again, be sure to ask the name of both companies.  If you're going to use the EAP benefit, you will need to ask how many sessions you are allowed and obtain a pre-certification or authorization number  for those sessions.  Write this information down to enter on your paperwork.  I will need it to file your claim for you.

4. Know Your Copay, Deductible, Out of Pocket

     You’ll also need to ask:  how much your co-pay is, how much your deductible is, if you’ve met your deductible yet, how much your out of pocket limit is and if you've met that.  If you haven’t met your deductible or your out of pocket limit, ask how much is left to be met for those.  Write all of this down.  This information will go on your paperwork.

5. Out of Network Benefits

     If I’m not a provider on your plan and you want to work with me, ask your insurance company for the same information above for your out of network benefits regarding pre-certification, copay, deductible, number of sessions, etc. Your copay may be a little more.  

6. Paying for Sessions Yourself - All Mental Health Costs Are Tax Deductible as Medical Expenses

     If you don't have insurance or you choose not to use it to protect your privacy and reduce the future possibility of being refused life or disability insurance, you can pay for the sessions yourself.  Mental health fees are tax deductible as medical expenses. Paying for your sessions gives you much more flexibility.  You can schedule sessions for more than 50 minutes.  You can schedule as often as you wish.  You won't need a diagnosis that is approved by an insurance company so you have the freedom to discuss, talk about, work on anything you wish.  Ten therapy sessions at $150 is less than a new TV.