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The Blog

The Insurance Maze

Emily Porta

Since it is the New Year, things are getting busier as people resolve to get help and start counseling. My number one question from callers..."Do you take my insurance?" And then I go into a bit of an education seminar. (Thought it would be a yes or no kind of answer? It really isn't!)

So here is what you need to know.

There are basically two different kinds of insurance HMO and PPO. HMO means you have to see their MD or therapist on their panel only. So if you use HMO, they should have a list for who is on their panel that you can see for your copay. If you don't want to use your HMO list, then that means you end up paying out of pocket. BUT you can use your flex spending account if you have one.

PPO means they have in-network and out-of-network therapists. Every PPO is different because your company negotatied the terms of contract with insurance company. So not everyone's Blue Cross PPO is the same. Your PPO will have a list of providers, but you can go outside of that list for help.

Call your insurance. Ask them a few questions. Ask them who manages your mental health benefits. You might have Aetna, but within Aetna, Cigna manages the mental health. You want to ultimately speak with a person that knows about your mental health benefits plan. Here are some other questions to ask:

-What is my coverage? You might discover you don't have any mental health benefits, so it is always good to ask. They should let you know if there is a limit to the number of sessions and the types of sessions (family vs individual).

-Let's talk about rates! So your insurance may say that you pay 20% of the fee and they pay 80%. But, you need to clarify this. Some insurance companies deterime the fee. My fee for example is $130/hr. But some insurance companies only reimburse at the rate they pay people on their panels. Typically, that rate is about $50 to $65/hr. Other insurance companies don't care what the therapist bills, they pay the percentage in the contract. 

-Is there a deductible and is it different for in-network and out-of-network providers? You might find you have a huge deductible regardless of if you stay in the network or not and this might inform your decision of which route to take.

-Do I have to have diagnosis? Every insurance takes a different stance on this since laws are changing and the government is trying to make it easier for people to get the help they need. You may or may not be comfortable with having a diagnosis. It is up to you and how you feel about that going on your medical record. 

Do you have to use insurance? NO! It is up to you. But as you can see, there are a lot of factors to consider. So after you call your insurance, give me a call. If you are still confused, I maybe I can help you sort it out :)

But no matter what you decide...don't give up and please get help. If you are struggling to pay for counseling, I have a few sliding scale slots and there are a ton of community counseling centers that have very low fees for their services.