| 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.
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:
- 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 |
Whatever mental health benefits you
use it is important for you to know
that, in using them, you will, almost
without exception be considered
mentally ill.
Mental health insurance rarely
reimburses 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.
Finally, it should be known that
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
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.
use it is important for you to know
that, in using them, you will, almost
without exception be considered
mentally ill.
Mental health insurance rarely
reimburses 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.
Finally, it should be known that
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
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.
Mental Health Insurance Information