You’ve Found A Therapist You Love. Now How Will You Afford to See Her?
Insurance Deductibles and Superbills and Self-Pay, Oh my!
Often, when new clients come to me, they already know what they need. They’re ready to do the work that therapy will inevitably ask of them. They often can tell if they want to work with me or not. Typically, they’re ready to book that first appointment. The only question left is: How will the sessions be paid for?
There’s no one right way to handle this. It really depends on a person’s situation. Some clients prefer to pay out-of-pocket. Some prefer to use insurance. And right now, with so many being furloughed or losing their job altogether due to the coronavirus pandemic, the need to rely on insurance due to financial uncertainty is more important than ever.
The thing is, many therapists—myself included—don’t take insurance at all or only accept insurance from certain providers.
There are a lot of reasons for this (more on this in a bit), but if you’re one of those who really needs to rely on your insurance right now, this can feel limiting and frustrating, especially since insurance companies often don’t make things very clear and easy to navigate.
But take heart! You may have more options to consider than you think.
First, let’s talk about why it is that some therapists don’t accept insurance and how this may actually be a benefit to you.
There are many reasons why therapists choose not to accept insurance, some of them practical, but many of them ethical. And these reasons are all ultimately about doing the most good possible for you.
So, let’s talk about some of the ethical issues specifically, because whether you’re aware or not, they directly impact you. Here are three things you should know about using insurance to pay for therapy:
In order for insurance to pay for your services, therapists have to provide them with a diagnosis and other private information about your session. Ethically speaking, this can veer into murky territory pretty quick. But really all that matters is that you’re aware of this, so that you can determine whether you’re comfortable with that or not.
Diagnoses stay on your record
People see therapists for all sorts of reasons, but only some of those reasons might be covered under your plan. If your insurance doesn’t approve of the diagnosis your therapist provides them, this could put your therapist in the difficult position of choosing a diagnosis that your insurance will cover even if it doesn’t quite match what you’re actually dealing with (or discontinuing working with you at all). Whatever diagnosis your insurance accepts, that stays on your records permanently and could be considered a “pre-existing condition”.
Your insurance company decides the course of treatment
This is possibly the most important thing to know about insurance because this will impact your therapeutic outcome. When they pay for your services, they determine how often you can be seen, how many sessions they’ll cover, and what you can be seen for. Decisions that you and your therapist make together in regards to your treatment plan is instead decided for you (without input from either of you) when insurance is footing the bill.
All that said, therapy paid for by insurance is often better than no therapy at all. My intention is not to dissuade you, but only to help you make the best informed decision possible. So, if you are in the position of needing to rely on insurance to cover your sessions, please use it. That’s what it’s there for.
“What if I find a therapist I love, but they DON’T take my insurance? What are the alternatives?”
If the therapist you want doesn’t take insurance, ask if they can produce a superbill for you.
A superbill is basically like an itemized receipt for your insurance company. It has all the important details your insurance company would need to process a claim:
The provider’s name and contact information
Your name, contact information, birth date and insurance information
Details about the visit, including the date, procedure/diagnosis codes, the minutes, and fees charged
It’s all intended to make filing and processing a claim as straightforward as possible.
This does mean that you would need to pay out of pocket for your session first, but your therapist can provide you with a superbill right then so that you can submit it for reimbursement.
“Does my insurance accept superbills?”
This is an important question, and likely one you’ll want to get an answer to before you go to your first session. Every insurance company handles superbills a little bit differently and it often depends on the type of plan you have. Some will reimburse you for 100% of what you paid, some only reimburse 40-60%, and others don’t accept superbills for therapy at all.
Typically, if you have a PPO plan, a superbill is a good option for you. But always do your due diligence by calling the 800 number on the back of your insurance card to double-check.
To make things easier, I like to provide clients with this list of questions to ask their insurance company for clarity:
Do I have mental health benefits?
What is my deductible and has it been met?
How many sessions per calendar year does my plan cover?
How much does my plan cover for an out-of-network provider?
What is the coverage amount per therapy session?
Is approval required from my primary care physician?
What is the time frame for reimbursing when the superbill is submitted?
Are couples or family sessions covered?
Are group therapy sessions covered?
How do I submit a superbill?
When submitting a superbill, be sure to send (via postal mail or online submission) not only your superbill, but also a copy of your insurance card. And keep copies of everything for your records.
It’s important to note that having a superbill doesn’t guarantee that your insurer will reimburse you, but it can definitely increase your chances of getting reimbursed if you want to file a claim. (That said, I’ve had many clients use them with great success.). And as with using insurance to pay outright for services, be aware that submitting a superbill is releasing private medical information about your care to your insurance company that they will keep on file.
Out-of-Network Claims Advocacy
Insurance plans have gotten more complicated than ever in recent years. So if figuring out your plan and making claims for out-of-network providers intimidates you, it’s no wonder.
Insurance companies often only provide clients with partial pictures of their coverage, and sometimes even give out misinformation. For example, often when you call in and ask, they will tell you if you have out-of-network benefits at all and what percentage will be covered. But, what they DON’T tell you is what your “allowed amounts” are or that “allowed amounts” are even a thing. (An allowed amount is the maximum amount your insurance will pay toward a service.). They will often tell you that they can’t tell you what those amounts are, even though they are legally required to.
But I have to tell you about this really cool app I found called Better. They are your pocket-sized patient advocate get you those hard-to-get answers about your coverage and can submit, track, expedite, and negotiate your claim reimbursements for you.
(For the record, no one is paying me to promote this app. I literally get nothing out of this except the joy of hopefully helping someone out.)
All you need to do is download the app and create a free account. (The app is currently for Apple devices only, but they have an Android app in the works as I type this. If you are an Android user, you can still use Better—you’d just need to create your account on someone else’s iPhone first, and then you can correspond with them and submit your claims via email.)
Once you have an account, you can not only email them your claims and superbills, you can also ask them questions about your coverage. Questions like:
“What are my out-of-network benefits?”
“How much of my deductible have I met?”
“I want to see this therapist. Will sessions with her be covered?”
“Does my plan cover group therapy?”
They can help you understand what is and isn’t allowed with your plan. Sometimes answers are quick and easy to get. Other times, they take longer. But either way, they always make sure to get answers, no matter how difficult your insurance company makes it.
The service is free to use. They only take out a small fee when your reimbursement claims get paid. So, it’s definitely worth trying it out and asking all the questions you need answers to! You can check them out by searching “Better Claims” in the App Store.
HSA or FSA Accounts
Health Savings Accounts (HSA) or Flexible Savings Accounts (FSA) can be another great option for paying for therapy. Many therapists accept them as payment and therapy generally is an approved expense category.
Even better: If you have an HSA or FSA to cover your therapy fees, you can still submit a superbill afterward for reimbursement!
Sometimes group therapy can be a more affordable route to getting the care you need. You might still end up having to pay out of pocket, but often at a fraction of the cost of what a therapist’s one-on-one rate might be. And it sometimes qualifies for reimbursement with a superbill as well.
Cost aside, you might even find that group therapy is preferable to one-on-one sessions because of the support, validation and insight you can gain from others, often with a common goal in mind.
Not every therapist offers group therapy, and if they do offer it, every therapist runs their groups a little bit differently, but it’s something that is worth inquiring about. (For my part, I really enjoy facilitating small therapy groups. My schedule doesn’t always allow it, but when I am able and when there is enough interest, I always try to work one in. I feel like they’re especially important now during a pandemic and economic crisis, when our stresses are multiplied and we need all the support we can get.)
All that is to say, if you find a therapist you’d love to work with, it never hurts to ask about group options. If they don’t have an option now, maybe they’ll open one up in the near future if they garner enough interest.
Finding a therapist you love and then finding out you can’t afford to work with them is never ideal. But, unfortunately, it happens.
Still, I think every therapist (or at least all the therapists I know) wants to make sure you’re taken care of, even if they’re not the right person for you. You can always ask them if they can provide you with names of other therapists they’d recommend based on your needs. We’re always willing to help you.
The search to find the right therapist for you can be a bit of a process sometimes, particularly when finances are a factor. But now you’re armed with information to help you make better decisions. If it takes some time and some extra phone calls, don’t give up. Finding that right fit is so worth it.
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