REIMBURSEMENT VIA OUT-OF-NETWORK OPTION
Paying out of pocket for mental health services is not a possibility for most people. For this reason we will write receipts for reimbursement for client’s with out of network benefits.
THINGS TO INQUIRE ABOUT
- Call you insurance company and ask if they will REIMBURSE for out-of-network psychotherapy sessions.
- Ask about your deductible. If you have met your deductible then your provider should reimburse and you would be responsible for just the co-pay.
Please contact your insurance company to determine what reimbursement they will provide.
Below are a few important pieces to be aware of, and consider, before you use in-network benefits.
CONFIDENTIALITY
Client’s health information (diagnosis, treatment plan, history, and progress reports), which must be submitted to insurance for payment, is not fully confidential as most clients think. Using insurance requires the client to carry a mental health disorder/diagnosis, which can have a lasting impact on a client’s health records, insurance premiums, and work promotions in some cases. We believe you should be aware of any potential impact.
Clients may be unaware that there are many situations where confidentiality must be waived. We have seen many situations where a client has had to waive his/ her rights to confidentiality for promotions at work, application into law enforcement, personal lawsuits for emotional distress, custody/ divorce proceedings, and life insurance. This means that these organizations/ boss will have access to your mental health diagnosis.
QUALITY OF WORK
Insurance companies have placed great restraints on the quality of work, a therapist can provide. Due to the extremely low reimbursement rate for services, we a practice can not survive on what insurance companies reimburse.
Typically, a therapist in a private fee-for-service practice, providing the type of depth work as we do, has a full-time caseload at about 20-25 clients per week. An insurance based practice needs 40-45 clients per week to earn a similar rate. We would not be able to provide the level of clinical competency we currently do, if we had to maintain a caseload of 45 clients per week. Our therapists would get burned out, and be unable to hold the quality of presence and energy needed for depth work.
WHEN USING INSURANCE FOR COUPLES THERAPY
In cases of couple therapy, very few plans actually offer couples therapy, which means the treatment needs to be billed under one partners plan, and he/she must be able to be diagnosed with a Mental Health Disorder.
Additionally, when couples come to therapy for systemic relational issues, having one partner carry a diagnosis can make the treatment feel unbalanced. This is something to keep in mind if you feel it may be difficult for you both. Especially if any issues arise around custody or divorce.
Be aware if you call another practice and they very-easily say they will take your insurance. Often times, they will diagnose the partner on the benefit plan, without your knowledge of the diagnosis.
If you wish to use out-of-network coverage – check with your provider to see if they cover couples therapy. If they do, then the above issues don’t apply. We would give you a receipt of sessions and you submit a claim form to your insurance company and they will reimburse you a certain percentage.
DIRECTION OF THE CLINICAL WORK
Insurance companies are trying harder than ever to limit the frequency and amount of sessions allowed. For lasting, permanent healing, long-term work is often needed. Insurance companies come from a place of medical diagnosis and focus on acute symptoms. Relational dynamics and hurtful attachment patterns, often caused from years of suffering, are not healed in 12-26 sessions. Therefore, the clinical work has more substance, and lasts longer than the band-aid approach that companies want to reimburse for.