Psychotherapy and Insurance Coverage

One of the most common questions asked by prospective clients is about medical insurance and whether the counseling services would be covered. They usually ask, “Do you take insurance?” and my answer usually is, “Does your insurance take me?!” That isn’t because of credentials, but because there are so many plans with various requirements for mental health coverage and providers.

HMO VS PPO:  First, it is important for you to know your own coverage. If you have an HMO, such as Kaiser, then know that you must go to a therapist through Kaiser, at their facility. Other HMO coverage through Blue Shield, Aetna or Blue Cross, for example, will have a provider list and you must pick a therapist in your area who is on that list. Unfortunately, I am not on any provider list for HMO coverage, but if, for some reason you do not wish to use your coverage or cannot find a suitable therapist in your area from that list, I am absolutely available to work with you. However, unfortunately, we will not be able to bill your insurance for reimbursement.

If you have a PPO, then there are several questions you need to ask your insurance carrier.

  1. What are my benefits for outpatient psychotherapy with an out of network provider.
  2. What is my deductible and is it different if I am using an out of network provider.
  3. Are there any restrictions for number of sessions per week or length of sessions?

When a patient wishes to utilize their medical insurance benefits for psychotherapy with me, I do require that you pay for the first several sessions up front until we see that the insurance company has started to reimburse for the sessions. I have the option of electronically billing so that the turn-around time is usually several weeks. You will not lose anything you have paid, as there is usually a copay and any extra will be credited against future copays. Also, some insurance companies do not send the payment to the provider, but back to you, so that you will pay for the session and be reimbursed by the insurance company. Once I send in the billing for the first few sessions, we can easily see how your insurance is going to work.

Unfortunately, many insurance companies have high deductibles for out of network benefits and you may have to pay up front for some months before the payments kick in. On occasion, I have had patients tell me they will wait until the deductible has been met before continuing, but understand, the only way to meet the deductible is to keep coming. The sooner in the year, your deductible is met, the more you will get the benefits of having some of your counseling paid for before the new year starts again!

Because of the advances in electronic billing, having your insurance help pay for therapy is easier than it has ever been. Once I have all your information correctly entered into a very secure and professional online billing program, provided by medical insurance companies for providers, then getting reimbursed for your sessions or having at least part of your sessions covered by your insurance is easily accomplished.

If you believe your insurance will cover some of your psychotherapy, or even if billing will just be reducing your high deductible, then bring your insurance information with you to your first session.  Further, in order to bill any insurance, we must have all the pertinent information on the primary insured.  So, if the patient is a dependent on the policy, we will need all demographic and insurance information for each member of the family.