Don't quit before you start!
When you pay out a hefty amount of money each month for your health insurance, you want to be able to use it for your healthcare needs. Therapy is a healthcare service that people often want to guarantee is covered by their insurance plan before scheduling that first appointment. For most people, choosing to start seeing a therapist is already such a difficult step. So many thoughts and feelings come up…
I should be able to handle this on my own
Many people have it worse than I do – they need therapy more than me
It’s not really going to help anyway
I don't understand how it will help
Unlike other healthcare services, there can still be still stigma, guilt, and shame attached to seeking mental health services. Add on top of that the idea that your insurance may not cover the cost and it's tempting to give up on therapy before you even get started.
Let’s break down the insurance game a little bit here.
HMO, PPO, EPO, and POS. What does all of this mean? If you have an HMO plan (Health Maintenance Organization), this means you need to stay within your designated network for any healthcare costs to be covered. If you chose a PPO plan (Preferred Provider Organization), you have the option to go outside of the "preferred provider" list and still get coverage for treatment costs. EPO plans (Exclusive Provider Network) are similar to an HMO in that your costs will not be covered if you go outside of the designated provider list. POS are similar to a PPO in some ways. You can see a provider outside of the network, but you will need a referral from your primary care physician. Let’s talk about the PPO and POS plans, in particular. You have opted to pay more for this type of plan, so take advantage of the flexibility that you have to choose a therapist that feels like the best fit for you. When you go outside of the preferred network with your PPO/POS plan, your insurance company may remburse a lower percentage of the fee than they would if you stay in the preferred network. This route is a bit more costly, but you get to choose the therapist that best meets your needs.
Why are so many therapists out of network?
One reason is because of the low rate that insurance companies choose to pay in-network providers. These rates are often well below fair health consumer rates and have not increased appropriately through the years. Check out Fair Health Consumer for more details about fair rates in your geographic area. To view therapy rates, you can enter billing/CPT code 90837. This will give you more information about average insurance reimbursement rates. There are other reasons that therapists choose to remain outside of a managed care network. The decision to not contract with an insurance company is often because providers do not want insurance to manage your care! Therapy is a deeply personal experience that requires individualized treatment planning to meet your needs. It is important for you to find a specialist in your particular area of concern, who has the proper training and experience to determine your course of treatment. Insurance companies usually require in-network providers to call them for an authorization to determine if therapy is "medically necessary", and they also may designate the number of sessions allowed. Although paying out of pocket is costly, you will have comfort in knowing that your therapist determines your length of treatment in partnership with you (rather than the insurance company). You are able to start talking to someone as soon as you decide you are ready!
How do you get insurance reimbursement for therapy fees?
As discussed earlier, you may be able to get reimbursement for your therapy sessions if you have a PPO or POS insurance plan. Your therapist can provide an invoice or “superbill” for you to submit to your insurance. This superbill will include information about diagnosis and fees. Once the superbill is submitted, your insurance company will determine the reimbursement rate. Typically, they will not reimburse the full fee if you see an out-of-network provider. However, some plans do reimburse very well. Navigating insurance reimbursement can be a daunting task, but there are now apps available that can help make this process easier for you. It’s important to choose a reputable app that is equipped to help with mental health claims so make sure to do research and find an app that you trust. Examples of apps that help with insurance and make therapy more accessible include Thrizer, Reimbursify, and ClaimEye.
Can I use my Health Savings Account for therapy?
Yes, if you have a health savings account (HSA), you can use this fund for mental health costs. HSAs allow individuals to put aside pre-tax dollars to cover medical expenses. These medical expenses include mental health services such as therapy sessions and psychiatry services. When you use your HSA to cover therapy fees, you can reduce your out-of-pocket expenses while prioritizing your mental health needs.
What is the cost of not engaging in therapy?
How will your life change if you do nothing and continue to struggle? How will your life change if you get the help and guidance that you need? Think about the income you may be losing by not taking care of your mental health. Are you missing work days? Are you functioning at your full potential to meet your goals? Improved mental health can lead to better relationships, increased productivity, and a greater sense of overall fulfillment. Investing in yourself and caring for your mind as well as your body has significant impact on your quality of life that is well worth the cost.
Most people dealing with a physical health issue will go to great lengths to make sure they get the care and treatment needed to recover and fully restore their health. Mental health care is equally vital for your overall wellbeing. Consider all of these factors when you determine the real cost of therapy.
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