Tips for using your insurance to pay for therapy
We’re just going to go ahead and say it out loud. Navigating health insurance can be a nightmare. Many people avoid dealing with insurance as much as possible because it can be so confusing. But, you’re paying hefty prices for that insurance policy so you might as well use it to your benefit.
More and more people are using insurance to pay for their mental health treatment. At Shift Counseling, PC, we think this improved access is a very good thing! If you’re struggling with depression, anxiety, trauma, or stress related issues, help is available.
Finding an in-network provider
Even if your policy provides coverage for mental health services, finding a provider and understanding your benefits can still feel overwhelming. The most direct way to get the information you need to move forward is to call your insurance company directly. Somewhere on your insurance card, there should be a “customer service” number, that you can call. Yes, you may sit on hold for a while, but someone from the insurance company should be able to provide you with a list of in network providers and explain what your out of pocket costs will be.
There are some great therapist finding widgets, such as Psychology Today, Mental Health Match, Latinx Therapy (as well as others) that can help you narrow your search by location, issues, and insurance type. A local Chicagoland resource is Therapy Road.
What types of insurance is Shift Counseling, PC in network with?
We are in network with BCBS PPO, Blue Choice PPO, many Aetna plans, and Cigna/Evernorth.
What if I have County Care, Medicaid, Medicare, or a Managed Care version of Medicaid?
Here are some links to the provider lists for these policies:
County Care - https://countycare.com/providers/
Medicare - https://www.medicare.gov/find-compare-health-care-providers
Illinois Medicaid - https://ext2.hfs.illinois.gov/hfsindprovdirectory/Main/SearchByOther
BCBS Illinois Community Health Plans - https://www.bcbsil.com/bcchp/getting-care/find-a-provider (Note: the people from BCBS Illinois Community plans are some of the nicest, most knowledgeable insurance people I have ever spoken to. Don’t be afraid to give them a call!)
Aetna Better Health of Illinois - https://www.aetnabetterhealth.com/illinois-medicaid/find-provider
Illinois Meridian - https://findaprovider.ilmeridian.com/location
What if I have “Obamacare” or an ACA policy?
Good news here: The in network provider list for ACA policies is pretty much the same as a regular commercial policy (a policy you get through your employer.)
What is the difference between an HMO and a PPO?
If you have an HMO policy, you will probably have to get a referral from your Primary Care Provider to a therapist who is in network with your HMO. This can be daunting, but it is the most affordable way to get mental health treatment if you have an HMO. Some HMOs provide out of network benefits, but we are seeing this less frequently lately. There seems to be a squeeze on out of network benefits, which sometimes leads to difficulty finding a mental health provider and long wait times if you have an HMO.
If you have a PPO policy, you generally do not need to get a referral for routine outpatient mental health services (such as weekly individual therapy.) There are often more providers who are in network with PPO policies as well. We are seeing a trend of outpatient therapy being covered as an “office visit” so the deductible does not need to be met before insurance starts paying for services. Instead there is often a reasonable copay for each session. Unfortunately, benefits vary WIDELY across different policies, so when in doubt, call your insurance directly to get the most accurate information.
Hot tip: if you think that you or someone in your family is going to need mental health treatment in the next year, consider choosing a PPO plan at your next Open Enrollment or Qualifying Life Event. Yes, PPO plans have a higher premium, but they may save you time, stress, and money in the long run if there is a need for mental health services.
What is Open Enrollment? Special Enrollment Period? A Qualifying Life Event?
Open Enrollment is when you pick your health insurance plans for the upcoming year (this usually occurs during the Fall.) A Special Enrollment Period is a time outside of the normal window of Open Enrollment when you can sign up for health insurance. A Qualifying Life Event is a change in your personal circumstances that would make you eligible to change your coverage outside of the Open Enrollment period. Hot Tip: Check out the list of Qualifying Life Events if you are stuck with an insurance policy that is not working for you. You may be able to make a change in your coverage mid-year.
Ok, I have been searching for an in-network provider and I can’t find anyone who takes my insurance. Help!
Unfortunately we have gotten several calls lately from people who have been searching for an in-network therapist for months. These types of stories are so sad to hear. Here are my top five tips for people in this situation:
1: Contact your insurer directly. They have a responsibility to help you out in these types of situations. No one should have to wait months for mental health services. This can be dangerous, and causes unnecessary suffering. Your insurer has an obligation to maintain a robust network of providers who can meet the needs of their members. When an insurer fails to have enough providers, it is called “network deficiency.”
2: If there is a network deficiency, you can request a “Gap Exception.” This would mean that you can request for an out of network provider be covered as in-network due to network deficiency. Here is a great article about Gap Exceptions and how they work. https://www.thesuperbill.com/blog/how-to-get-an-out-of-network-exception-gap-exception-for-health-insurance (thesuperbill.com has lots of great articles about insurance coverage on their blog)
3: If you still can’t get help, see if you are eligible for a Qualifying Life Event to get you out of that policy that is not working for you.
4: At your next Open Enrollment, choose a better insurer or a PPO plan, if possible.
5: If you still can’t find an in network therapist and can’t afford to pay full price out of pocket, check out Open Path Collective, which is a non profit dedicated to helping people find affordable mental health coverage. https://openpathcollective.org
What is different in the world of Outpatient Therapy in regards to Insurance Coverage?
How much time do you have? Because I have THOUGHTS on this subject. I’ll keep it brief here.
For many years, therapy was considered something for the “worried wealthy.” Being able to go to therapy was often seen as a privilege for those who just happened to have an extra $200-$250 a week laying around that they could use to pay someone to listen to their problems. Things have changed so much in the past few years regarding health insurance coverage of therapy.
The Mental Health Parity Act of 1996 was the beginning. Insurers used to frequently deny coverage for mental health services, but this law made it necessary for insurance companies to pay for any mental health services that are medically necessary, the same as physical health services. After years of being forced to pay for mental health treatment, a positive outcome has been that insurers are actually learning that providing outpatient behavioral health services can significantly decrease overall health spending. Outpatient behavioral health services add value for both insurers and their members. https://www.fiercehealthcare.com/payer/cigna-study-how-much-behavioral-health-treatment-can-lower-total-cost-care
It used to be that if you were getting mental health treatment, it was because you were either very privileged or very sick. For many years, there wasn’t much mental health access for most of us that fall in between those two categories. So much has changed in the past couple of decades. Many more people have been recognizing that they need help for issues such as depression, anxiety, trauma, or stress related conditions. It is much easier to get help with your mental health. Stigma is decreasing and access is increasing.
There have been major improvements, but we still have so much work to do to increase access. If you’re interested in a deep dive on the topic of current barriers to affordable mental health treatment, here is a very comprehensive article. https://www.americanprogress.org/article/the-behavioral-health-care-affordability-problem/
