Understanding your mental health insurance benefits

Understanding your mental health insurance benefits

This might be the understatement of the year: It can be very difficult to understand one’s health insurance policy. It can be even more difficult to figure out your mental health benefits as different plans treat mental health care differently. This post will help you figure out how to proceed once you’ve taken the brave action of deciding to get treatment. Please note that the information we are offering below is just general advice and we can’t provide specific information–you’ll need to contact your insurance company for more detailed and accurate information. Also note that this information is primarily directed at individuals in the U.S.

What is the difference between “in-network” and “out-of-network”?

In-network means the provider (doctor, psychologist, counselor, etc.) is part of your insurance company’s insurance panel. Out-of-network means that the provider is not part of the panel and does not “participate” in your insurance.

How do I find an in-network provider?

Typically insurance companies will have websites with a “Find a Doctor” function. You can also call them and they can email you a list of participating providers. Be sure to enter you exact plan because this will affect who is or is not in-network. When you do find a doctor, verify that they participate in your insurance before your actual appointment, just in case the information you received from the insurance company was out of date.

What if I can’t find an in-network provider I want to see or none have availability?

Insurance companies may struggle to attract providers to be in their network and therefore there aren’t many providers available. This can be because reimbursement rates (what therapists get paid by the insurance companies) can be very low, and these providers have difficulty covering their administrative and overhead costs with those lower rates.

If this is the case, you’ll likely need to see someone “out-of-network”–if you have out-of-network benefits. Check your policy for clarity on whether or not you have out-of-network benefits. If you don’t have any, you will not be reimbursed. Often, individuals who see mental health providers, whether psychologists, social workers, counselors, or psychiatrists end up paying “out of pocket” for treatment and then submitting for reimbursement from their insurance company.

How do I use out-of-network benefits?

In order to use out-of-network benefits, you’ll typically see your provider, pay out of pocket (cash/check/credit card) and then submit your receipts to your insurance company for reimbursement. How much your insurance company will pay you back and how many sessions it will cover varies by company and policy.

How do I know what it’ll cost me?

To find out what you’ll end up paying for treatment, we suggest following these steps:

  • Contact your insurance company and find out what out-of-network benefits you have.
  • Ask what your deductible is (what you will need to pay before reimbursements begin)
  • Ask what is the allowable rate for therapy sessions. Some example of the codes your therapist might use: 90791 (Psychotherapy Intake), 90834 (Individual Therapy Session 38-52 minutes), and 90837 (Individual Therapy session 53+ minutes)
  • What percentage of the allowable rate will you reimburse me?
  • How do I submit my claims for reimbursement?

Navigating your health insurance, and especially your mental health benefits, is never easy. It’s important, though, to take good care of yourself and we hope that this blog post has answered some of your questions!