FAQ

Here are some frequently asked questions for your perusal. If you have any other questions, feel free to call our offices or contact Dr. Davis by e-mail.

  • Insurance 101–Should I use insurance for psychological services?
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    Insurance 101–Should I use insurance for psychological services?

    the nutshell:

    1. you must have a psychiatric diagnosis to use insurance for mental health services.

    2. You provider must be a member of your insurance company’s provider network (or you must have out of network benefits and these usually have deductibles that are higher and different from your medical deductible).

    3. Marriage therapy is not covered by health insurance (there is no billable diagnosis for marriage problems.)

    4. Insurance controls the number of sessions

    5. Some insurances pay or not based on their assessment of need.

    6. May insurances do not include mental health benefits.

     

    Health insurance can be a wonderful and necessary thing. Discussions of the need some kind of broad coverage of health insurance is an important issue that is being widely discussed by current political candidates. Certainly, if you get sick and need expensive care, such as hospitalization or intensive, in- office procedures, insurance is vital. But is may not always be such a good thing to use insurance for mental health care, particularly if you want to use therapy as a means of personal growth. It can can be particularly problematic for marriage therapy. This article is meant to educate people- i do it everyday as most people do not understand how health insurance works for Mental Health. (Just for your information, Dr. Davis does not accept insurance for marriage therapy.)

    Details- Details (as boring to read as it was to write- but you may need to know this before shopping for a therapist)

    Here are some of the main issues of concern in using insurance for mental health services.

    • In this day and age, most insurance companies have “provider networks” and will not pay other out of network providers at all. Network member providers have agreed to follow the insurance guidelines and to accept (usually) a substantial discount for provided services. The low payment for health sefvices paid to physicians is a growing problem, but is particualrly so for mental health providers. Usually we agree to accept approximately 1/3 to 1/4 of our normal fee for basically an hour of our time. You should check with your insurance company first before calling around to therapists.
    • Having great health insurance does not mean you have great mental health benefits, primarily because policies are put together by the employer, often with different companies providing medical and mental services. This means you can’t be sure who is on your plan when seeking therapy unless you really do some investigation. Currently there is no mental health parody, meaning that benefits are not equal for mental health than for medical treatment. Since the employer chooses the policy, it can be quite lacking when it come to mental health benefits.
    • If you purchase your own health insurance, mental health is often not a part of the plan at all.
    • Many mental health policies are inadequate, with strict limits on the number of available sessions. The insurance company also reserves the right to not pay if they don’t believe the patient is “sick” enough. The insurance Sometimes, you won’t know for months that they won’t pay and get stuck with the bill after all- and what a hassle trying to get it all worked out. Got lots of time to hang on hold?
    • You have to have a psychiatric diagnosis in order receive payment for services- just as your medical doctor must give you a medical diagnosis to receive payment for his services. Further, Insurance companies are notorious for passing protected information within their own ranks. Information such as diagnosis, nature of treatment, and other pertinent information (from the insurance company, not from your counselor) is fed into a national medical information database (MIB) that centralizes information for approximately 700 insurance companies. MIB states that it was designed to prevent fraud on insurance applications. At the very least, they would have on record that you saw a counselor for some type of mental disorder. This database information is accessed if you subsequently apply for any individual health, life or disability insurance for 7 years. And, since you have to have  sign a general release (when buying insurance for yourself), the insurance company can get more detailed information from the previous insurance company that paid for the treatment. And that can include more details about specifics of plans, goals, treatment information or more. (For $9.00 you can obtain a copy of your record at MIB. It is worthwhile to check for accuracy in all your medical records.) Years down the road, a bout of depression could be out there on your medical record in the insurance data base, affecting your ability to get insurance because you are a “risk”.
    • As previously stated, you must have a psychiatric diagnosis for insurance reimbursement. Since there is no current diagnosis for family or couples (relationship problems), you can’t really use insurance for those services. (However, some professionals will tweak the diagnosis and service codes they submit to insurance companies for payment to be acceptable. There is always a chance they will refuse payment. Sometimes the insurance company will even lead you to believe that they pay for those services. In reality, it is insurance fraud to “tweak” the claims to get payment for couples or family problems. Sometimes a therapist can justify seeing a couple together by suggesting that the diagnosed patient needs the spouse to attend as part of their treatment.) I have had many insurances refuse payment billing for couples counseling. For that reason, among others, I do not accept insurance for this work.

    So, as you can see, their are some compelling reason to not to use insurance for therapy services. This is not an exhaustive list, I just got tired of writing about it. Please feel free to ask more about these issues with a free consultation or

    If you are intent on using insurance, contact your insurance to verify coverage and get a list of participating providers. It is not always clear as to what your policy covers and to who are the covered providers (many mental health policies are written differently from the standard health insurance and have a different list of in network providers.)