5 Things to Consider About Mental Health Insurance Coverages

Most health insurance plans offer some level of coverage for outpatient psychotherapy, however the actual benefits vary tremendously depending on your provider. It is important for you to place a call to your insurance company to understand your options and potential liability and prioritize what’s important to you.

Determining what’s important to you in paying for mental health services is a necessary first step. Insurance benefits may be financially advantageous, but not provide the level of confidentiality and flexibility you desire.

• Is your participation in mental health treatment private from members of your family?
• Does your condition / concern recommend specialized treatment modalities?
• Do you have financial resources to pay $125 – $300 per therapy session?
• Is your ability to attend therapy further from home hindered by your job or family obligations?
• Does your insurance plan have outpatient mental health benefits?

In-Network Mental Health Coverage

In-network mental health benefits will cover psychotherapy only with the professionals who sign contracts with the insurance company to provide services for you at a negotiated rate. The insurance company authorizes the number of sessions allowed for certain mental health conditions.

Insurance companies require regular treatment plans to be submitted by their in-network providers to continue authorizing sessions. There can be a lack of clarity or after-the-fact decisions about what the insurance company will cover in-network, resulting in surprise balances billed to patients. Insurance companies can and do audit in-network psychotherapists’ records, further compromising confidentiality.

Working with an in-network Texas therapist, Licensed Social Worker, counselor, etc. can be more cost effective, but limit your options in what skills your desired professional will have and how far you must travel.

Out-of-Network Mental Health Plans

Out-of-network benefits cover psychotherapy with the professional of your choice. Most plans require you to pay a deductible first, and then they reimburse a percentage of the fee once your deductible is met. Your psychotherapy sessions do not require authorization. Some insurance companies will agree to reimburse the psychotherapist directly so you do not have to pay as much out-of-pocket at the time of a session.

Using out-of-network benefits likely will provide you with more flexibility and control over your therapeutic process, the frequency of sessions, the treatment modalities you can benefit from, and identifying the certifications or special trainings you desire in a therapist. In addition, when using these benefits your therapist is not required to provide the detailed records as outlined above, giving you more confidentiality.

How I Work with Clients in Dripping Springs, Texas

My practice is out-of-network for many insurance plans, but I do assist my clients in obtaining reimbursement from your insurance company.

Offering out-of-network mental healthcare allows all treatment decisions to be made between you and me, including the type of therapy used, its length, and who should or should not be consulted.

Fee-for-service therapy has the highest level of security and confidentiality, as only a judge may request my client records via a subpoena. Insurance companies are not involved, thus your mental health diagnosis will not become part of your medical record and stays only between you and me. This choice protects you from acquiring a pre-existing behavioral health condition on your medical record.

If I am an in-network provider for your insurance, I’ll file all claims for you via my billing service. If you have other insurance, you can check your policy for “out-of-network mental health benefits,” which may have a higher co-pay and deductible. If you have this option, you may be reimbursed by your insurance company for a portion of my fee. I will give you receipts that you can file for reimbursement with your insurance company.