• Anna F Jolliff, Counseling Intern

Therapy 102 : Defining Counseling


[PART TWO of THREE]

It can be hard to find the willingness to give counseling a shot. And once you've found the courage, harder still is navigating the world of insurance. To complicate matters, the rules of medical coverage don't always apply in the mental health setting (also called behavioral health).

We sincerely wish that so many clients didn't have to deal with insurance. (As therapists, we also wish this for ourselves!). For clients, nothing exacerbates anxiety like hopping on the phone with an insurance company. This post will hopefully help to demystify the process of finding insurance coverage for your first counseling appointment, and all the ones to follow.

First, two important caveats:

(1) We recognize that it is a huge privilege to have health insurance in our country, and particularly coverage for behavioral health. Not everyone has the means, or makes the choice, to pay for health insurance.

(2) We also recognize that not everyone chooses to apply their insurance to therapy. It is certainly possible to pay for counseling out-of-pocket -- that is, without using health insurance at all -- and it may be a good option for some people.

That being said, this post applies to people who have health insurance, and who would like to use it to help them pay for therapy.

First Step: The Dreaded Phone Call

1. You've found the courage to try out therapy. Amazing! You may already know what therapist you want to see (perhaps you received a referral from a friend), or maybe you're looking for someone in-network*, close to your home or workplace, or who specializes in your particular concern. The first thing to do is to call the number listed on your insurance card or on the insurance company's website. (You can probably sift through your plan to find this information yourself but, as a counselor, I can vouch for the fact that it can be easier just to talk to a human.)

Things to ask the insurance representative on the phone:

1. Do I have behavioral health coverage? (All marketplace insurance plans should, but the degree of coverage varies between plans).

2. How do I know which providers are in-network? (They can point you to a list).

3. Is there a session limit?*

4. Are there any mental health diagnoses which insurance will not cover? Which ones? (If the representative can't or won't answer, the therapist you find may also have knowledge of this, based on their experience with that particular insurance company.)

5. How much is my deductible for behavioral health insurance?*

6. How much is a typical copay for a therapy session?*

7. Do I need a referral or pre-approval from my doctor, or from my insurance company, in order for insurance to cover therapy?

Second Step: Deconstructing the Dreaded Phone Call

Ok. So the person on the phone was nice (ish?), but she talked way above your head. Of course, asking that lady is your first line of defense, but assertiveness skills are something we can work on in therapy! The second line of defense is reading through this list of definitions to help you make sense of what was said:

In-Network: Many therapists contract with at least a couple of different insurance companies. This means that the therapist agrees to meet certain requirements dictated by the insurance company. In exchange, the therapist can now say he or she "accepts X insurance" and is a viable option for any client carrying that insurance. Win win, kind of.

What you need to know: In-network therapists will often be cheaper for you, and there is no inherent difference in the quality of in-network versus out-of-network therapists.

Prior authorization/pre-approval: Some insurance companies require that a doctor "pre-approves" you for therapy. Hopefully, yours does not require this. If they do, it means your doctor has to say, "this patient would benefit from mental health services" before insurance will cover you to see a therapist.

Alternatively, your insurance company may simply require you to receive pre-approval over-the-phone by one of their behavioral health specialists. These specialists function much like the doctor: asking you uncomfortable questions and then concluding something you probably already knew (i.e., you should see a therapist).

Do I dislike this? Yes. Is it still true? Often, yes.

After you've passed the prior-authorization/pre-approval process, you'll be cleared to see an in-network therapist. You should also take a moment to engage in self-care, because jumping through hoops is hard.

Third Step: Paying for Stuff

Deductible: this is the dollar amount that your insurance asks (okay, demands) you pay out of pocket before they begin to help pay for therapy. You have to meet your deductible every fiscal year.

For example, if you have a $1,000 deductible, and your therapist is priced at $100 for a 60-minute session, you can expect to pay for 10 sessions yourself before your insurance begins to pay.

Copay: Whew! Done paying off that deductible. Now it's time for some free therapy, right? Wrong. (Sometimes). You'll often be required to pay a copay, which is the amount that you will continue to pay out of pocket for each subsequent session after paying off your deductible. Luckily, this is typcailly way cheaper than the full cost of a session (more like $20-35).

Co-Insurance: Co-insurance is similar to a copay, meaning that you are expected to pay your co-insurance at the time of services. The difference, however, is that co-insurance requires you to pay a set percentage of total service cost. For example, if your co-insurance is set at 20% and the fee for a 60 minute therapy session is $150, your co-insurance portion would be $30. If the session cost was $200, you would owe $40.

Session Limit: This is the number of sessions that your insurer will pay for, typically per year. (The name, at least, is intuitive.) Not all insurance companies will set a session limit. If yours does, your therapist can work with them to get more sessions, as needed.

Remember: We didn't say this part doesn't suck. We DID say -- and we sincerely believe -- that jumping through all these hoops is worth it.

Other FAQ

1. What if I went through all this work (above) only to find a therapist who is full of S***? (Or, less aggressively, we just didn't click.)

Three things:

1. Not to worry! Most of the work you just did is necessary before using insurance to see any therapist. So you've saved yourself a lot of time on the next go-round.

2. Do not stick with the therapist just because she was hard to find. Fire your therapist, feel sorry for yourself for a while, pat yourself on the back for your fortitude, and then go find a new therapist!

3. If it takes you several tries to find a good therapist, it's probably just luck of the draw. However, if you go through more than 10 therapists -- well -- we can talk about that in therapy!

Happy Therapist Hunting, my Friends!

*definition provided in article

Do you have a question about counseling that wasn't mentioned here? We would love to hear it using the comment section below!

Make to share this using the buttons below and visit our website to learn more about Abegglen Counseling.

[This article does not create a client-counselor relationship. This article is general counseling information and is not to be considered legal or medical advice. Please consult with your mental health professional before you rely on this information.]

[This article does not create a client-counselor relationship. This article is general counseling information and is not to be considered legal or medical advice. Please consult with your mental health professional before you rely on this information.]


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