|
| |
Understanding Your Insurance Benefits
To many, health insurance has become a confusing mass of alphabet soup. Once
upon a time there was only a fairly standard 80-20 indemnity plan. Now there are
HMO’s PPO’s, MHO’s and “carve-outs”. How do these
changes effect your mental health benefits? How do you find out about your
benefits?
The insurance industry has changed to meet the cost-controlling needs of the
employers. The main distinction with the mental health portion of your insurance
has to do with PPO vs. Managed Care. You often will not
know if you have a “managed” plan until you call the phone number on the back of
your insurance card. With many insurances, such as Blue Cross HMO, Blue Shield,
Cigna, United Health Care, etc., the mental health
portion of the coverage is “carved out” and sub-contracted to a managed plan,
such as Managed Health Network (MHN), United Behavioral Health (UBH), and Cigna
Behavioral.
With a PPO, you may choose any contracted doctor and the fee will be paid at a
specified rate. Co-pays tend to remain the same and there is a maximum number of
sessions allowed per year. With some plans you may choose an “out of network”
doctor but the deductible and co-payment rate may be more.
With managed care, you first need to call the intake department and request a
referral to a “mental health specialist.” After the therapist has seen you for a
number of sessions (1,3,5,10 depending on the plan) he/she
must fill out and send in a form or call a reviewer to request more sessions. If
the reviewer feels the treatment is “medically necessary” and fits a short-term
therapy protocol, more sessions may be granted. While there is
generally little or no deductible, co-payments are often graduated to higher
levels as treatment continues.
While your plan may state a maximum number of sessions per year, that number of
sessions may not be realized, if the case reviewer does not see the treatment as
necessary. Other drawbacks to a managed care plan have to do with
confidentiality and third party decision makers. Some people chose to avoid all
of this and pay out of pocket.
To clarify your actual benefits, call the number on the back of your insurance
card. You often will be referred to another number when you ask about
“outpatient mental health.” Be prepared to give your policy number (usually the
social security number of the insured), the insured’s name and the insured’s
employer.
You will want to ask how many sessions are allowed per calendar year, what is
the deductible and what is the co-pay or applicable percentage per session. You
should ask if the therapy is “managed.” You might also want
to ask if there are “out of network” benefits and what they are. With answers to
these questions, you will have a better idea of what kind of therapy your health
insurance actually affords.
New Parity Law
Press this link to learn how the new Parity Law may improve your ability to
afford psychotherapy.
Insurance Contracts
Press this link to see which Insurance Companies our Doctors work with.
Wilmes-Reitz Psychological
23945 Calabasas Rd., Suite 202
Calabasas, California 91302
(818) 591-8270
wrpsych@aol.com
|
