Many insurance plans will allow you to choose the provider you prefer to work with, even if you don’t have a high deductible. This freedom is outlined in your “out-of-network benefit”. I am happy to check on your out-of-network benefits by calling your insurance company, if you wish. We can then talk about how your benefits work in my practice. Also, if we work together using your out-of-network benefit, I can bill the insurance company for you, so you don’t have to do it, or I can provide you with a bill so that you can handle reimbursement yourself if you prefer.
It is also important to understand that you also always have the option to use Private Pay whether or not your insurance company provides in-network or out-of-network benefits. Many of my clients have chosen to utilize Private Pay, even when they have the option of insurance coverage instead. Here are a few things to consider when determining whether Private Pay will work out better for you than utilizing Out-of-Network (or even in-network!) benefits:
- Many plans have a high deductible that may be very difficult to meet. You may be among the growing number of people who must pay a deductible amount before the insurance company will reimburse for any services. If that’s the case, you’ll be paying out-of-pocket. I can easily check with your insurance company to find out the details of your mental health benefits.
- When you choose to use insurance, I’m required to share aspects of your private health information with your insurance company. The degree of detail depends on each insurance carrier’s requirements at any given time, but at a minimum I will be required to disclose a diagnosis, the number of sessions, and the duration. This is also one of the reasons that there are some insurance companies I simply do not work with. When we work without disclosure requirements imposed by insurance carriers:
- I do not have to provide a psychiatric diagnosis for your permanent medical record.
- I do not have to give details of your care to your insurance company.
- You do not have an insurance record that may be used to establish a “preexisting condition” that may disqualify you from health insurance or life insurance benefits in the future or interfere with your coverage if you change insurance policies.
- You do not have mental health information that is retained in an insurance company’s database that may be subject to data security incidents or breaches.
- I can give you the highest degree of privacy with regard to your records.
- When you choose to use insurance, I’m required to adhere to the restrictions of the insurance company concerning the duration of your sessions, the frequency of your sessions, and the diagnosis and treatment options that the insurance company will pay for. Some of my clients have been surprised when they find that their insurance company will not pay for coverage beyond one 45-minute session per week, or that the most appropriate diagnosis or treatment will cause a coverage issue with the insurance carrier. When we work without the limitations imposed by insurance:
- We can do the type of coaching and therapeutic work that is best for you and most effective in overcoming your challenges and reaching your goals.
- We can meet for the ideal duration of each session given the issues that may arise and that you choose to address during that session.
- We can schedule sessions with whatever frequency fits your goals, needs and life demands —even if it doesn’t fall into an approved model of care designated by your insurance company.
- I can give you the highest degree of specialized coaching and/or diagnosis and treatment uniquely suited to you.
Please call me about payment options, insurance benefits, and coverage! If you think that I may be the right therapist for you, I can help you understand and work through payment options.