Basics of Insurance Coverage for Private Psychotherapy
- Category: Coping Strategies
Mental Health Insurance: Research Your Policy
If you want or need (or both) financial reimbursement for part of your psychotherapy treatment please research your insurance policy. Insurance policies define who and what they will cover in terms of mental health. This is not determined by the service provider, but is determined by your insurance company and your particular policy.
Three Main Categories of Policies Related to Mental Health Insurance
Some policies, like PPO policies, cover a certain amount of the mental health provider's fee when you use a service provider included on the insurance company list of preferred providers.
Those policies will also cover services, but to a lesser degree, when a qualified and credentialed service provider is not listed with the insurance company, i.e. an out of network provider. Some policies, like HMOs, only cover mental health service providers who are signed up with the HMO company. Other policies are POS (point of service) policies where you can see any mental health provider you choose as long as she or he is qualified, credentialed and offers services for conditions covered by the policy.
My Practice (Joanna Poppink,MFT) as an Example
For example, I am an independent service provider, a mental health clinician, i.e. I am licensed and have a private psychotherapy practice. I am not listed on any HMO panel. I am not on any PPO preferred provider list. I am qualified, and I have credentials. I am a fee for service provider. This makes me an out of network provider. HMO policies will not reimburse for my services.
For patients to get full or substantial insurance reimbursement for the cost of working with me, they need to have POS insurance. To receive partial reminbursement they need to be signed up with a PPO. Then a certain percentage of my fee will be reimbursed, usually with a maximum amount for each year. Both POS and PPO policies must specifically cover the conditions for which treatment is sought and the services I offer.
Need for Accurate Mental Health Insurance Coverage Information
I'm posting this information because many people with eating disorders who are looking for treatment ask if the psychotherapist accepts insurance. The question is really, "does the insurance provider accept the mental health clinician?"
Once you research your policy, you will be able to ask a private practice clinician: Are you a preferred provider with my insurance company?
Are you signed up with (on a panel with) my HMO?
If you ask the questions appropriate to your coverage you will have a much better position to look at your money issues and what will be involved for you to receive the treatment you need.
You will also have more realistic information regarding your financial situation so you can determine your next step.
Good luck! Useful insurance information link from Psychology Today: Ins and Outs of Mental Health Insurance