Navigating Your Mental Health Insurance Benefits

Chris Potter education health insurance licensed under CC BY-SA 2.0

Chris Potter education health insurance licensed under CC BY-SA 2.0

Navigating mental health benefits can often be a confusing and stressful experience.  Uncertainty about services being covered in or out of network and determining how to best finance mental health services is a big obstacle for many people thinking about getting help. If you have health insurance and want to determine if and how to can be used to help with the cost of counseling, the first steps involve learning about what mental health specific benefits you have.

If you have a web log in for your insurance policy, you can log in and start looking under eligibility and plan details.  If you don’t use your insurance company’s online platform, you can call the member services number on the back of the card.  Either way, prepare to make this call or log in when you have devoted at least 20 minutes to focus and write down the information you are looking for.  It is best not to feel rushed when learning about your benefits in order to make sure all the information you are getting is accurate.

When working with a therapist or counselor who does not take your insurance, you will want to find out if you have ‘out of network benefits’.  Out of network benefits involve your insurance company reimbursing you for receiving care from a provider that is not in network or in contract with them.  Essentially, you still go about paying for services upfront, and then your insurance will reimburse you directly if it all matches your policy benefits. If you do have out of network benefits, you’ll then want to ask the insurance representative about what percentage of the services will be reimbursed. It is also important to make sure you are aware of any deductible that must be met before the reimbursement eligibility begins.  Sometimes, insurance policies will also have limits on the number of sessions they will cover, and will specify if you require a referral from your primary care physician or not.  Many insurance companies require a reimbursement form be submitted with a copy of the receipt of services provided.  Make sure your provider gives you a receipt that has all the necessary information on it in order to get reimbursed.

Although it might sound like a lot of work, health insurance benefits can often alleviate some of the financial stress of paying for mental health services and can increase your access to services.  In order to use insurance for any type of mental health service, including family and couples counseling, all insurers require that the person receiving the service is assigned a mental health diagnosis and treatment code of the therapy provided for the diagnosed concern.  When you use your insurance as the payer, your therapist is also required to share the details of your treatment plan, including presenting problems, treatment goals, and interventions with your insurance company.  For these and related privacy reasons, many people choose to pay directly for services themselves in order to ensure that their insurance company does not get involved with their personal reasons for being in counseling.  Weighing the good and less good things about using insurance to pay for mental health services is a personal decision that requires careful consideration.  Many therapists and providers, including staff at Long Island Mental Health Wellness Counseling, are happy to discuss these concerns during an initial consultation when making decisions about starting services.  Taking the first step by reaching out to a provider in your area is a great way to start learning about what is involved with beginning counseling and overcoming any obstacles to care that could interfere.

Share
  •  
  •  
  •  
  •