I know the world of insurance is a very confusing matter. If you're considering using your insurance to pay all or part of the services you receive, I've outlined some helpful guidelines to make it easier:
Many times the phone number to call to get your benefit information is located on the back of your insurance card under 'Behavioral Health or Mental Health Services'; if there isn't a number specifically for this, then call the number for 'Member Services'.
When you call, you'll want to talk to a customer service representative concerning your 'out-patient behavioral health benefits'; if you get a never ending menu of automated options, press 0 or just say, 'customer service representative'.
Ask the representative for your 'out-patient behavioral health or mental health benefits' and make sure they answer all of the following questions; be sure to write down the information:
If you have 'in-network benefits', I have agreed to receive a negotiated amount that is less than the fee-for-service rate, however, you won't be responsible to pay for the difference. You will only be responsible for the above deductible, co-payment, and co-insurance at the time of service. I will then bill your insurance company directly, and they will pay the rest.
If you have 'out-of-network' benefits, typically payments are based on the full fee-for-services but insurances will pay a percentage of the fee. As with in-network benefits, only the deductible, co-payment, and/or co-insurance will due at the time of service. Then I will bill your insurance company directly and they will pay the rest. In rare instances, however, some clients will need to pay the full amount upfront, get a receipt from me, and then bill the insurance themselves.
Also, you may be able to access your benefit information on-line. For more information about how to do so, contact your employer’s Human Resoures Department.
BE AWARE that your behavioral/mental health coverage may NOT be the insurance logo that's named on the front of your insurance card. Sometime medical insurance carves out the mental health portion of your benefits to a different carrier. In order to accurately verify your benefits, you MUST contact the right department and the right insurance carrier. If you're using the phone number on the back of your card to verify benefits, be sure to call the number indicated for behavioral health or mental health benefits services.
ALSO, BE AWARE that although your card may list co-pay amounts for office visits on the card itself, mental health visits aren't always included in these office visits. Even when MH co-pays are listed, they aren't always accurate for your current benefit plan. It's always in your best interest to verify your benefits by calling the appropriate number.
And last, be aware that insurances will reimburse for services that are 'medically necessary'. Generally, this means insurances will pay the cost of treatment if you are experiencing distress that cause sufficient inner turmoil, physical or cognitive symptoms, and/or a decline or inability to perform in day-to-day life. In my experience, it's unusual for a person to seek counseling if they aren't experiencing some degree of symptoms or difficulty with everyday life. However, if this would occur, I will inform you after our first visit and then you would have the option to either pay out-of-pocket or discontinue services.
While I sincerely sympathize with the confusion that comes with insurance, please understand, if you use insurance, it's still your responsibility to know your benefit information and any changes to your benefits that occur during the time you're in therapy. Ultimately, you are financially responsible for theses services, and anything not covered by your insurance will be due from you. Therefore, it's in your best interest to know and understand the information before your first visit and any time there's a change in your insurance policy.
If you have any questions or concerns about insurance, feel free to contact me at least 48 hours before your scheduled appointment, and I'll be glad to assist you.