Questions to Ask Your Insurance Company Before Starting Counseling

I understand that counseling is an investment and if you're already paying an insurance premium, you want to use the services that might be available. Even though I don't accept insurance (except EAP direct referrals), there may be options for you to use insurance to cover a portion of your counseling services.

First of all, you can use an HSA card (Health Savings Account) to pay for counseling/therapy services. It's actually super easy... just use the card like any other credit card and we're good to go!

This is also something to consider if you're planning to pay for counseling ongoing and need to decide how much you'd like to contribute to your HSA each year when your company has open enrollment.

Secondly, consider other ways insurance might contribute. I recommend everyone call their insurance company to ask the following questions before beginning counseling with any practitioner:

>> How much is your deductible?

It is important to understand how much you need to contribute out of pocket each year before your insurance "kicks in." This varies greatly depending on your insurance plan so you must talk with your HR department and/or insurance company to know this number.

>> How much have you contributed to your deductible as of this point in time and when does that reset?

Perhaps you've had some other large medical expenses and have already met your deductible, so most medical expenses are now covered by the insurance. Or perhaps you're still $9,538 away from meeting it... who knows! 

Although many deductibles reset at the beginning of the year, some reset based on the employer's enrollment schedule, which can be at any point in time. Make sure you know this date so you can anticipate when you'll need to cover expenses again.

>> Are out of network providers covered under your plan?

Some plans, typically plans that are PPO, allow you to choose any provider for any health service. This is a genuine open market so that you can choose whomever is the best fit for your needs. However, you will initially need to pay for this service out of pocket and then seek reimbursement from your insurance company, so plan for a time gap. 

>> If yes, at what rate will they reimburse you for the following CPT codes billed by a licensed psychologist: 90791, 90834?

These are the two codes I typically use for billing your initial session and ongoing sessions. There are different rates for different kinds of therapists, so make sure to note that I'm a psychologist (this is typically reimbursed at a slightly higher rate than Master's level therapists). 

You can click here to learn more about my fees, but I generally charge $200 per session. Subtract whatever amount you will be reimbursed to identify how much you'll need to contribute out of pocket.

>> If no, does the insurance company offer single case agreements so that you can see an ADHD specialist?

This only applies if you're seeking services specifically for ADHD, but may be an option. There are times when insurance companies do not have someone in network to meet your specific need. In those cases, they may allow me to contract with them for a single case agreement. This means that I'm still not on their panel, but they will pay me directly to see you.

However, if they have someone in the area who specializes in ADHD and has openings, this likely is not an option. Additionally, if you're looking for help with general work stress or career issues, insurance companies will view any licensed mental health clinician as capable of providing that service and are not likely to make an exception. 

Taking it from here...

I know dealing with insurance is complicated. Ahem, that's a big part of why I choose not to do it! However, I do have some experience in this area so feel free to contact me if you get confused or have any other questions after talking with your insurance company. 

And remember that if you do choose to use your insurance, they will have access to my notes about our work together. They will also require that you meet criteria for a mental health diagnosis in order for us to work together. While I would love to #endstigma around mental health disorders, I also understand there are many reasons you may not want that kind of information easily available to others. 

There are also many cases where people do not meet criteria for a mental health disorder but would still find counseling helpful. In fact, this is a large portion of the clients I see regularly. They are "typical" people dealing with a stressor, looking for insight and wanting some support. And, like it or not, insurance doesn't pay for that. 

Hopefully, this helps you make more informed decisions about how you choose to pay for counseling, both now and in the future! Please feel free to share this post with others to help #endstigma around mental health and make sure your friends and family have the information they need about using insurance.