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Paying for Mental Health Services


     Many mental health care providers accept multiple insurance plans but for various reasons a growing number of providers are not taking insurance and only offer fee for service. While providers offer different services, there is no direct correlation between the quality or type of service offered and whether they accept or do not accept insurance. The decision to use your insurance plan to go in-network or to go out-of-network with a fee for service provider is a personal one depending on your circumstances, but two considerations should be born in mind.


    To get the full benefits of therapy, an individual will need to commit to regular, usually weekly, sessions over time. There is no rule of thumb for how long it will take because much depends on the type of therapy, the complexity of the issues, and the individual’s personal challenges. Even medication management will require regular visits with the provider. It may be tempting to take short cuts, be inconsistent with compliance, or to terminate treatment early, but doing so will mean the benefits will be short lived. Therefore, when choosing a provider, you should take into consideration your resources to meet these financial commitments without becoming financially over stretched.


    On the other hand, it is important that the right services are secured to meet your therapeutic needs. Not choosing the right provider can compromise the benefits received from the treatment, irrespective of the time you commit to your treatment. You should feel comfortable with the therapeutic relationship as that plays a significant role in the quality of the treatment, the skills and scope of practice of the provider to deliver what you are looking for, and any other traits you consider important to build trust and confidence in the provider’s ability to provide the help you need. Otherwise, the experience of therapy, and even medication management, will be unsatisfying, unhelpful, and there is a higher likelihood that you may terminate your treatment early.


     Ideally, you would want to satisfy both these conditions in one place but when a choice has to be made, or when one consideration overrides the other, then the following information may help you to make the best decision under the circumstances. 


Insurance


     For those who have insurance coverage for mental health care services, it is natural that you would want to use it. The coverage helps to make mental health care services more accessible and manageable. In this case you will need to find a provider who is in network with your insurance company. Since coverage can vary from plan to plan even from the same insurance company, it is best to check with your plan to fully understand what services are covered, for how long, and the respective copay for each session. Typically, almost all insurance plans have some amount of copay to be paid by the client. The provider will file your claim on your behalf with the insurance company and charge you the copay. Insurance companies provide a list of mental health care providers who are paneled with them and this can be a good place to find providers who will take your insurance plan. Typically, there is a wide choice of providers to choose from. A provider who takes your insurance may also be able to help you understand your coverage.


     In order to use your insurance plan, you will have to be given a formal diagnosis of a mental health disorder. Your mental health care provider will discuss your diagnosis with you and the diagnosis will be recorded on your medical history. While this is normal practice, it would be wise to understand the implications of this, which may or may not be relevant for you, but that is for you to decide. The diagnosis will go into your medical history and this may or may not impact you if you decide to change your medical insurance provider. In some situations, such as certain jobs, what is in your medical records may have an influence. Many insurance plans these days have a high deductible, therefore, sessions may not be covered for quite some time. Consequently, even though you are using your insurance plan, you may not receive the financial benefits of the coverage for quite some time and your experience may be that of a fee for service arrangement.  


Self-Pay


        While self-pay may appear to be expensive, almost all fee for service providers will provide a super bill to file for out of network insurance coverage. In this case the copay for you maybe a little higher, but for many plans, insurance still covers most of the expenses. It is best to check with your insurance plan to find out the difference between in network and out of network coverage prior to beginning treatment if this is an important consideration. It is important to point out that a super bill will also have a formal diagnosis for the insurance company and so that too will be added to your medical history.


     Going out of network offers a wider choice of mental health care providers, you are not restricted to just those on your insurance panel. This maybe important if you need to work with a specific provider who offers specific services important for your treatment, such as if you have requirement relating to culture, language, specific issues, type of therapy you want, population, e.t.c.


     While all mental health providers will provide a diagnosis for treatment, the diagnosis is not formally recorded in your medical history. Not having the diagnosis formally recorded in your medical history does not impact the quality of treatment, since treatment is still guided by the diagnosis. Medical insurance companies have no access to any information from providers not on their insurance panels, therefore, you have more control over what happens to your information. Working out of network also offers greater flexibility to tailor the treatment and delivery of services completely to the needs of the individual without restrictions set in the insurance policy. You will pay your provider in full at the end of the session, but if required your provider will give you a super bill that you will be responsible for filing with your insurance company for out of network reimbursements. Your provider is not involved in any communication with your insurance company and the insurance company will reimburse you directly.