Understanding Insurance

Understanding insurance coverage for mental health / behavioral health services can be challenging. Benefits can vary significantly from company to company and among different policies within the same company. Some policies (HMO’s) limit which therapists a patient may see (and have those services covered). Other policies (PPO’s, POS’s, etc.) may allow more flexibility in whom the patient may see (and have those services covered), but the patient may be required to assume more financial responsibility to see clinicians considered out-of-network. Patients utilizing these benefits may be required to pay a higher deductible before services will be paid and the co-pay (the amount the patient is responsible for at each visit) may also be higher.

HRA (Health Reimbursement Arrangement) and HSA (Health Savings Account) plans are also popular healthcare plans. HRA plans are employer-funded medical reimbursement plans in which the employer annually sets a specific amount of pre-tax dollars for health care expenses for employees. The primary requirements for an HRA are — the plan must be funded solely by the employer, not by salary reduction, and the plan may provide benefits for substantiated medical expenses only.

HSA’s are similar to personal savings account. The money deposited in not taxed and can be invested in such instruments as stocks, bonds or mutual funds. The employee, not the employer or insurance company own or control the money in the account. The money placed in this account can only be used for health care expenses and to be eligible, the HSA must have a ‘high deductible’ or ‘catastrophic coverage’ insurance plan.

Additionally, most behavioral health policies have a limit on the number of visits or a dollar maximum that will be covered each year. In addition to the traditional behavioral health benefits, some employers offer EAP benefits in which a limited number of visits (generally three to five) are provided without the patient being required to pay a co-pay.

It is also very difficult (impossible?) to keep up with all of the insurance company mergers and although nearly every insurance company provides behavioral health benefits, it is not uncommon for these benefits to be managed by a different company than a patient’s medical benefits. As a result, our therapists may actually be considered providers for insurance companies in which initially they did not appear to be credentialed. To further add to the confusion, if a therapist is not considered an ‘in-network’ provider, a therapist may be able to provide services through a patient’s ‘out-of-network’ benefits.

Because understanding insurance benefits is so confusing, we gladly verify benefits before setting an initial appointment. It is important to note that we make every effort to accurately determine a patient’s insurance benefits. We also submit a patient’s insurance claims and perform reasonable follow-up with the insurance company. However, on occasion the benefit information provided us by an insurance company may differ from a patient’s actual coverage. Actual coverage can only be determined upon receipt of the insurance reimbursement and the patient remains financially responsible for all charges.

Because each of our therapists is in independent practice at The Psychology and Counseling Group because many insurance companies credential therapists individually, not every therapist affiliated with The Psychology and Counseling Group is considered a provider for every insurance company.

Follows is a list of some of the insurance companies some of our therapists are providers for: AETNA, BLUE CROSS / BLUE SHIELD, CIGNA HEALTHCARE, HEALTH CHOICE (ORHS), MEDICARE, UNITED HEALTHCARE, VALUEOPTIONS, TRICARE, ETC. Some of our therapists are also providers for Employee Assistance Programs (EAP’s) including AETNA, BLUE CROSS/BLUE SHIELD, JET BLUE, NEMOURS, UNITED, VALUE OPTIONS, etc.