Insurance, EAP, Community Support, and Budgeting
We all know that accessing healthcare can be daunting, especially when it seems (or is) not affordable. Here are some options to check out that may make it easier for you to get going with a provider.
If you’re paying for it-may as well see what you can get from it, right? The easiest way to find out what your plan offers is to just call the number on your insurance card (and it’s also a good opportunity to practice managing emotions and reactions as you breathe patiently through the fiftymillion prompts until you get to a person). So after you get through to a human, what do you ask?
Hi, I’m calling to find out about my mental health benefits through my plan.
At this point, the lovely representative will likely tell you if you have a deductible, which is the amount you would have to pay before the insurance will pay for services. Even if you have a high deductible, most insurance plans require that therapists only charge the rate that they would receive from the insurance company. For example, if the insurance company pays the therapist $80 for a traditional 55 minute session, the therapist can only ask this of you, rather than the self-pay rate they may have. After the deductible is met, there may be a co-pay or the insurance may cover the session in full. A co-pay is the portion of that example $80 fee that you would be responsible for. So if your co-pay is $20, your therapist would bill the remaining $60 to your insurance. This is at least how it works in my practice. Some therapists prefer to have you handle the insurance by submitting bills/statements to the company so that you can be reimbursed directly by the insurance.
If you are calling to be referred to provider, the insurance company will provide a list of in-network providers, but if you are connected to a therapist already that is NOT in-network, you can ask if your insurance provides out-of-network benefits. My experience has been that not many do, but it’s worth asking anyway.
Also make sure to ask specifically about the type of counseling you are doing. Individual sessions are billed in various increments and standard for my practice is an individual 55 minute session (code 90837), but I’ve also billed for inclusion of family members, or for shorter sessions, so you will want to ask the insurance company specifically if they cover couples or family sessions, as not all may. Further, I am finding that most plans cover in office sessions at the same rate as online sessions, BUT that may be true. Luckily, there have been cases where the plan actually offers better benefits for online sessions, which was a nice surprise!
*Please be aware that to use your medical insurance, providers have to provide a diagnosis and prove that sessions are “medically necessary” to access your insurance benefits.
Employee Assistance Programs
I’ve been finding that many people do not know about their EAP benefits, which is a shame, because there are usually free sessions! EAP benefits usually include a variety of services, with the idea that a supported employee is a more effective employee. Companies usually outsource these benefits, so it’s important for you to ask and understand the name of the company that is providing the mental health/counseling sessions (i.e. ComPsych, Health Advocate, Cigna). This is separate from insurance and my experience thus far has been that I do not have to provide a diagnosis to the company. EAP is intended to be short-term stabilization/connection to resources and the 3-10 sessions can do just that. For those that want to continue with their counselor, they typically continue through self-pay or use of their insurance. Since we already know that EAP is short-term, if you have an idea you would like to continue with the counselor, it’s best to discuss this up-front.
Hi, I’m calling to find out about counseling sessions available through your program; can you tell me how it works?
The lovely EAP representative will likely ask you what issue you are working on (as they sometimes provide additional sessions for a different issue later on), who it is for (EAP sessions may sometimes be available to family members), and if you have specifications for a provider (location, demographics, takes whatever insurance). If you already have a counselor in mind, the EAP company can see if they are already contracted with them or may be willing to on-board the counselor, which your counselor may or may not choose to do.
EAP rep. will then notify the provider that they’ve been assigned to you, and/or will provide you with an authorization number (*remember* to ask and write down how many sessions/dates allowed to give to your therapist). The therapist usually submits a request for payment directly to the EAP company without needing you to do anything.
There are various free or low-cost options for various needs and each agency will usually specify through their website or a phone call what those requirements are. For example on the Mental Health Association of Central Florida’s website, their criteria for the Outlook Program is: over 18 years of age or older, primary psychiatric diagnosis of depressive or anxiety disorder, comorbid medical conditions, permanent residence in Orange County, uninsured, and of preference, recent medical hospitalization or visit to the emergency room. A quick online search for “free counseling in *your city*” should return some leads to explore in your community.
There are also national resources such as Open Path Collective that gather counselors who are willing to provide low cost services to those that sign up/qualify.
Many counselors also provide spaces for “sliding scale” for those who cannot afford their full-fee. This would be negotiated according to the therapist’s practice. While I would not be able to pay my own bills if I offered sliding scale to everyone, it is important to me that people get the help they need, whether that is with me or another option.
This is the path I chose for myself as I don’t have an EAP program and I wanted to continue with the provider I was already working with, even though she does not take my insurance. I’ve had to do some mental cartwheels around this to reframe how I view where my money goes. This really only became clearer after I kept better track of where my money was going. When I found that I was spending more on going out to restaurants than on my health, I had to make some adjustments because while socialization and experiences do contribute to my own healthy state of mind, I needed to find a better balance. So, I add it to my “medical” budget each month and adjust other budget items as needed to be able to make this happen for myself. Interestingly…I have found that by doing “the work” with her, my money/budget habits have improved anyway!
Regardless of what path you choose, it’s important to determine your “why” and the strength of your “why”, which will fuel your determination to finding any way to get the support you need.