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  • Writer's pictureAnissa Bell, LMFT

Here's a Look at the Bottom Line on Therapy Cost

Updated: 32 minutes ago

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 services. 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.


Healthcare Information
Healthcare costs

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. However, if you chose a PPO plan (Preferred Provider Organization), you have the option to go outside of the "preferred provider" list. With a PPO plan, you are able to choose your own provider and your plan will cover some of the cost of treatment. 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 that 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.


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 we do not want insurance to manage your care! Therapy is a deeply personal experience and requires individualized treatment planning to meet your needs. It is important for you to find a specialist in your particular area of struggle, 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 really 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 as soon as you are ready!

6 Tips to scheduling your therapy appointment

 

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 these include Thrizer, Reimbursify, and ClaimEye.


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? Investing in yourself, caring for your mind as well as your body, can have 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 important for your overall wellbeing.

Anissa Bell, LMFT, Clarity Therapy Associates, California

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