What's covered by your health insurance.
This is a common question we hear from our clients. Yes, health insurance provides some coverage for psychotherapy. Before you decide to use it, it's important to know the details to make an informed decision about using health insurance to pay for psychotherapy.What’s covered.
Currently the California Mental Health Parity Law of 1999 requires that insurers cover specific severe mental health diagnoses to the same extent they cover medical conditions. This translates to more coverage and comprehensive benefits to the following severe mental illnesses:
- Anorexia and bulimia
- Bipolar disorder
- Major depressive disorders
- Obsessive Compulsive Disorder (OCD)
- Panic disorders
- Schizoaffective disorder
The Mental Health Parity and Addiction Equity Act (MHPAEA) of July 1, 2010, mandates mental health benefits to be equal to medical coverage provided by the plan. This covers most plans and requires equal coverage for all mental health and substance abuse diagnoses covered by the plan. However, this law does not apply to individual or small business plans (employers with less than 50 employees). This too allows insurers to limit coverage based on insurances’ definition of medical necessity, and plans to manage therapy visits, authorizing a few sessions at a time.
Medicare and MediCal Plans
If you are covered by Medicare or MediCal plans, please take a special note; currently, these plans do not cover the cost of psychotherapy including intensive outpatient programs.
Who can treat you.
With PPO or POS Plans
You can choose a therapist from the “Preferred Provider” or in-network list of your health insurance company or you can choose an out-of-network therapist. The reimbursement rate will be higher if you choose from those preferred by the insurance and will be lower if you choose an out-of-network provider. PPO plans tend to reimburse based usual & customary fees, but the insurance plan determines what fee is “usual & customary” and generally not representative of actual psychotherapy fees.
With HMO Plans
You are required to choose a provider who is on your insurance network. Since most skilled, successful therapists don’t take insurance or limit their participation, finding an effective one for you may require some effort on your part. Be sure to check how many sessions are covered by your plan and at what co-pay to make sure that using your insurance feels right to you; weigh the actual financial benefit against the downsides of compromising your privacy, a coverage that may not meet your treatment needs, and restricting your choice of providers.
Your privacy is compromised.
When you use your health insurance, your therapist must justify your need for therapy to your insurance company, which typically requires the therapist to provide your mental health diagnosis and sensitive personal information about your therapy. This information will go into health insurance files that can be accessed by numerous people. This is an ongoing process, often requiring justification every few sessions.
This is also a consideration if you think you may want to be self-employed in the future. Past mental health diagnosis and treatment records may be treated as a pre-existing condition, which will make private insurance more difficult and expensive.
Also, more and more skilled, qualified mental health physicians and therapists are choosing NOT to participate on managed care health insurance network. The reimbursement rates are low, the paperwork is time-consuming, and the coverage is limited and tightly managed making involvement of the insurance company difficult. This trend may impact your ability to get the best care. If you are concerned about whether or not you can afford therapy without insurance, contact Mind Therapy Clinic and inquire about our low cost therapy.