| MENTAL HEALTH INSURANCE INFORMATION |
| . |
Introduction: As you may have discovered, using insurance can often be very complicated. This is unfortunate. In order to make it as simple as possible though, I will try to provide you with some useful information. If the following information seems complicated, do not hesitate to contact me. You may also wish to read the following just a little at a time.
Insurance companies and policies can vary greatly. For now, we will just concentrate on your mental health benefits.
Diagnosis requirement: Usually, insurance companies require that you receive a mental health diagnosis. That is, they require that you are diagnosed with some sort of a mental disorder and that this disorder is reported to them. The diagnosis must have a name which can be found in the Diagnostic & Statistical Manual of Mental Disorders (DSM). This has to do with something called "medical necessity" which means that treatment of a mental disorder must be medically necessary before an insurance company will pay for it.
Even if found in the DSM, insurance companies will not pay for the treatment of all mental disorders. Usually this is because they believe the disorder has no known effective treatment or they believe it is not truly a mental disorder. Insurance companies will usually pay for an initial consultation even if no formal and billable diagnosis is found. It will be important to discuss your diagnosis with your therapist at your first session.
Marriage counseling: Although there are exceptions, most insurance companies will not pay for marital therapy. In order for couples or families to be seen together, most insurance companies require, officially, that at least one person to be diagnosed with a bonafide mental disorder. Relationship difficulties may be the primary focus of treatment, but officially, the treatment is to be in service of the person with the diagnosis. This is due to the fact that, at present, most all diagnoses are given to individuals.
Privacy and stigma: Many people are uncomfortable with the idea of being diagnosed with a "mental disorder." Although my own views steer away from seeing people as "mentally disordered," a diagnosis is nonetheless required for insurance reimbursement. Although, I am able to provide you with a greater amount of privacy than most providers, I am unable to guarantee you will receive the same level of privacy once you information is given to your insurance company. Something called the Health Insurance Portability and Accountability ACT (HIPAA) allows a lot of sharing of your information with or without your permission. This is why I have taken steps to not belong to HIPAA and this is why some people choose to pay out of pocket rather than use their insurance.
Although, a certain amount of information must be given to your insurance company in order for me or for you to receive reimbursement, the amount of information is minimal. Sometimes insurance companies require treatment plans, but by law, they are not allowed to see session notes.
Using your insurance: If you plan to use insurance, you will need to fill out my Insurance Information Form along with a few other forms which can be found on my Forms Page. You will want to call your insurance company's customer service. The number is usually on your insurance card.
Questions to ask:
Insurance companies are used to answering these questions and it will be useful to you and to me if you know these things before you come in. There are other questions, many to
which I already know the answers and many to which I can have answered by calling your insurance company myself.
Insurance companies I work with and those I don't: Therapists have had various experiences with insurance companies. If their experience has been positive, they are going to be more willing to work with the company again. If their experience has been negative, they may be unwilling to work with them directly. If I am unsure of an insurance company for some reason, I may ask that you pay me directly at the time of service and then seek reimbursement yourself. If this is the case, I will provide you with the information you need and if you are prompt in submitting your claim, you may expect reimbursement from your insurance company within 30 days. 30 days is the time the law allows. Prompt submission of your claims is advised because some insurance companies require you do this within 45 or 60 days from the date of service. Following is a brief overview of the insurance companies my clients have had policies with and the way I will work with them:
Blue Cross/ Blue Shield: I am completely confident in BC/BS and will be happy to bill them for you. This means you will only need to pay your deductible and co-pays. I will be the one to wait for 30 days for reimbursement.
Note: Since initially constructing this page, there have been changes in the insurance industry. Any instance below in which I've stated that I may be open to accepting certain insurance policies may no longer be the case. This simply means that we may need to arrange for you to pay me directly at the time of service and seek reimbursement on your own. I will be happy to discuss this with you in greater detail.
Managed Health Network (MHN) associated with HealthNet: I will be happy to bill MHN for you. MHN usually caps my fees at an amount less than I charge. This means you may need to pay the difference between this "cap" and my full fee in addition to your co-pay. You may wish to speak with me about this. MHN's policies may affect treatment in that they usually only authorize 8 sessions at a time. At about session five, therefore, decisions will have to be made about further sessions.
Aetna: I have started to have good experiences with Aetna and may be willing to bill them directly for you.
ODS: I have started to have good experiences with ODS and may be willing to bill them directly for you.
LifeWise: I will be happy to bill LifeWise for you. It will be very important however for you to ask them all the questions outlined above. I am not on their panel, and often, people insured by them are required to pay very high deductibles before their insurance kicks in. Even then, co-pays are often high. This may not be the case with every policy, so again, it will be especially important to check.
!! Cigna, United Behavioral Health, Providence, & PacifiCare: Although insurance companies may change for the better or worse, my most recent experiences with these companies have not been good ones. Some of these companies are related to one another and have been successfully sued in class action law suits for intentionally withholding, delaying, & denying payment to providers. They also may be unwilling to reimburse Oregon Licensed Psychologist Associates. I will not, at present bill these companies for you.
Insurance companies and policies can vary greatly. For now, we will just concentrate on your mental health benefits.
Diagnosis requirement: Usually, insurance companies require that you receive a mental health diagnosis. That is, they require that you are diagnosed with some sort of a mental disorder and that this disorder is reported to them. The diagnosis must have a name which can be found in the Diagnostic & Statistical Manual of Mental Disorders (DSM). This has to do with something called "medical necessity" which means that treatment of a mental disorder must be medically necessary before an insurance company will pay for it.
Even if found in the DSM, insurance companies will not pay for the treatment of all mental disorders. Usually this is because they believe the disorder has no known effective treatment or they believe it is not truly a mental disorder. Insurance companies will usually pay for an initial consultation even if no formal and billable diagnosis is found. It will be important to discuss your diagnosis with your therapist at your first session.
Marriage counseling: Although there are exceptions, most insurance companies will not pay for marital therapy. In order for couples or families to be seen together, most insurance companies require, officially, that at least one person to be diagnosed with a bonafide mental disorder. Relationship difficulties may be the primary focus of treatment, but officially, the treatment is to be in service of the person with the diagnosis. This is due to the fact that, at present, most all diagnoses are given to individuals.
Privacy and stigma: Many people are uncomfortable with the idea of being diagnosed with a "mental disorder." Although my own views steer away from seeing people as "mentally disordered," a diagnosis is nonetheless required for insurance reimbursement. Although, I am able to provide you with a greater amount of privacy than most providers, I am unable to guarantee you will receive the same level of privacy once you information is given to your insurance company. Something called the Health Insurance Portability and Accountability ACT (HIPAA) allows a lot of sharing of your information with or without your permission. This is why I have taken steps to not belong to HIPAA and this is why some people choose to pay out of pocket rather than use their insurance.
Although, a certain amount of information must be given to your insurance company in order for me or for you to receive reimbursement, the amount of information is minimal. Sometimes insurance companies require treatment plans, but by law, they are not allowed to see session notes.
Using your insurance: If you plan to use insurance, you will need to fill out my Insurance Information Form along with a few other forms which can be found on my Forms Page. You will want to call your insurance company's customer service. The number is usually on your insurance card.
Questions to ask:
- Do I need pre-authorization in order to receive treatment?
- Do I have a deductible? How much is it?
- How much is my co-pay?
- Unless your insurance company is Blue Cross/ Blue Shield, I will not be on your insurance company's "panel." Ask if you have "out of network" privileges.
- Will they pay for treatment by an Oregon Licensed Psychologist Associate? If they say no to this, simply make note of it and I will speak with them myself.
- How many sessions am I allowed?
Insurance companies are used to answering these questions and it will be useful to you and to me if you know these things before you come in. There are other questions, many to
which I already know the answers and many to which I can have answered by calling your insurance company myself.
Insurance companies I work with and those I don't: Therapists have had various experiences with insurance companies. If their experience has been positive, they are going to be more willing to work with the company again. If their experience has been negative, they may be unwilling to work with them directly. If I am unsure of an insurance company for some reason, I may ask that you pay me directly at the time of service and then seek reimbursement yourself. If this is the case, I will provide you with the information you need and if you are prompt in submitting your claim, you may expect reimbursement from your insurance company within 30 days. 30 days is the time the law allows. Prompt submission of your claims is advised because some insurance companies require you do this within 45 or 60 days from the date of service. Following is a brief overview of the insurance companies my clients have had policies with and the way I will work with them:
Blue Cross/ Blue Shield: I am completely confident in BC/BS and will be happy to bill them for you. This means you will only need to pay your deductible and co-pays. I will be the one to wait for 30 days for reimbursement.
Note: Since initially constructing this page, there have been changes in the insurance industry. Any instance below in which I've stated that I may be open to accepting certain insurance policies may no longer be the case. This simply means that we may need to arrange for you to pay me directly at the time of service and seek reimbursement on your own. I will be happy to discuss this with you in greater detail.
Managed Health Network (MHN) associated with HealthNet: I will be happy to bill MHN for you. MHN usually caps my fees at an amount less than I charge. This means you may need to pay the difference between this "cap" and my full fee in addition to your co-pay. You may wish to speak with me about this. MHN's policies may affect treatment in that they usually only authorize 8 sessions at a time. At about session five, therefore, decisions will have to be made about further sessions.
Aetna: I have started to have good experiences with Aetna and may be willing to bill them directly for you.
ODS: I have started to have good experiences with ODS and may be willing to bill them directly for you.
LifeWise: I will be happy to bill LifeWise for you. It will be very important however for you to ask them all the questions outlined above. I am not on their panel, and often, people insured by them are required to pay very high deductibles before their insurance kicks in. Even then, co-pays are often high. This may not be the case with every policy, so again, it will be especially important to check.
!! Cigna, United Behavioral Health, Providence, & PacifiCare: Although insurance companies may change for the better or worse, my most recent experiences with these companies have not been good ones. Some of these companies are related to one another and have been successfully sued in class action law suits for intentionally withholding, delaying, & denying payment to providers. They also may be unwilling to reimburse Oregon Licensed Psychologist Associates. I will not, at present bill these companies for you.
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| Christian Wolff, Psy.A., Licensed Psychologist Associate • Psychotherapist & Counselor 820 NW 21st Avenue, Suite B. Portland.Oregon. 97209. 503.381.2032. christian@christianwolff.com |
If you decide to use health insurance for therapy or counseling you must receive a psychiatric diagnosis which is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and without exception, be considered mentally ill.
It is extremely rare that any health insurance entity will reimburse for marital counseling, and if there is marital counseling, it must be seen as being in service to the mental health treatment of one the parties or another.
Increasingly, as well, insurance companies are not reimbursing the treatment of many of the mental disorders described in the DSM (see link to the left). They are insistent that the diagnosed disorder be a "serious" one and they have their own ides about what these are. At times are rather secretive about their standards, not informing you or your provider about them until treatment has already begun.
This is not to dissuade you from seeking treatment. Psychotherapy and counseling have been shown to be of great benefit to millions and millions of people. The purpose of this page, in part, is to help you make informed decisions about insurance use.
As we all know, in our current times, health care coverage, policies, and programs are in great flux. We may have good hope that Americans will be assured of better health options, but for now, we see trends in which premiums, deductibles, and out other out-of-pocket expenses such as co-pays are on the rise while benefits are decreasing by leaps and bounds.
Mental health does not stand alone. General medical benefits have been going the same direction.
Given how much is no longer reimbursed, many are questioning the value of paying large amounts for insurance they cannot use. All added up (do the math), insurance may cost more than paying directly and fully out-of-pocket for the services you use.
Many people have looked into Health Savings Accounts (HSA's) which combine catastrophic (lower cost) insurance with savings accounts which unlike insurance premiums, can be used when needed and the money kept when not needed for health matters. Consider researching HSA's on the Internet, by talking with friends, or by consulting a bank or an accountant. There are by law, some significant tax advantages to using HSA's which could save you further money.
Many people may be quite happy with their insurance policies, and of course, some policies may be better than others. Many may not mind allowing insurance companies as opposed to mental health and medical professionals making a large proportion of the calls regarding privacy and treatment decisions. Many have had very good experience with their insurance companies and may have other reasons for enjoying the security of health insurance coverage.
increasingly, good psychotherapists and counselors are deciding to not accept insurance at all. This means that in addition to restrictions your insurance companies place on which providers you may see, the therapist Finally, it should be known that you may wish to see may not accept insurance. This too sheds light on the value of keeping and paying for mental health insurance. What is the use of having insurance if only therapists unacceptable to you will take it? Please call your insurance company prior to seeking any services you believe you may want or need and press them until you are clear on the matter. Certainly your past experience with your insurance company is a worthy thing to consider, but policies change year to year and sometimes, month to month with or without your knowledge. For assistance on your call to your insurance company, you may wish to use a page I have prepared for people who are planning to use insurance to pay my services. Go to Insurance Information Parts I & II on this website.
It is extremely rare that any health insurance entity will reimburse for marital counseling, and if there is marital counseling, it must be seen as being in service to the mental health treatment of one the parties or another.
Increasingly, as well, insurance companies are not reimbursing the treatment of many of the mental disorders described in the DSM (see link to the left). They are insistent that the diagnosed disorder be a "serious" one and they have their own ides about what these are. At times are rather secretive about their standards, not informing you or your provider about them until treatment has already begun.
This is not to dissuade you from seeking treatment. Psychotherapy and counseling have been shown to be of great benefit to millions and millions of people. The purpose of this page, in part, is to help you make informed decisions about insurance use.
As we all know, in our current times, health care coverage, policies, and programs are in great flux. We may have good hope that Americans will be assured of better health options, but for now, we see trends in which premiums, deductibles, and out other out-of-pocket expenses such as co-pays are on the rise while benefits are decreasing by leaps and bounds.
Mental health does not stand alone. General medical benefits have been going the same direction.
Given how much is no longer reimbursed, many are questioning the value of paying large amounts for insurance they cannot use. All added up (do the math), insurance may cost more than paying directly and fully out-of-pocket for the services you use.
Many people have looked into Health Savings Accounts (HSA's) which combine catastrophic (lower cost) insurance with savings accounts which unlike insurance premiums, can be used when needed and the money kept when not needed for health matters. Consider researching HSA's on the Internet, by talking with friends, or by consulting a bank or an accountant. There are by law, some significant tax advantages to using HSA's which could save you further money.
Many people may be quite happy with their insurance policies, and of course, some policies may be better than others. Many may not mind allowing insurance companies as opposed to mental health and medical professionals making a large proportion of the calls regarding privacy and treatment decisions. Many have had very good experience with their insurance companies and may have other reasons for enjoying the security of health insurance coverage.
increasingly, good psychotherapists and counselors are deciding to not accept insurance at all. This means that in addition to restrictions your insurance companies place on which providers you may see, the therapist Finally, it should be known that you may wish to see may not accept insurance. This too sheds light on the value of keeping and paying for mental health insurance. What is the use of having insurance if only therapists unacceptable to you will take it? Please call your insurance company prior to seeking any services you believe you may want or need and press them until you are clear on the matter. Certainly your past experience with your insurance company is a worthy thing to consider, but policies change year to year and sometimes, month to month with or without your knowledge. For assistance on your call to your insurance company, you may wish to use a page I have prepared for people who are planning to use insurance to pay my services. Go to Insurance Information Parts I & II on this website.