Understanding Insurance is really complex and can be challenging when you’re trying to seek mental health counseling. Below I provide some bullet points based on our practices experience with insurance companies. I’ve also included the Pros/Cons of using insurance.
Using Insurance (Pro’s and Con’s):
Here are a list of Pro’s for using insurance for your mental health services.
- You already pay (or your company pays) for your healthcare benefits, why not use them!
- You receive discounted rates. For example our 55 minute session rate is $135 (goes up $5 each year). Out of pocket you pay that full rate. Using insurance you pay our contracted rate- this is what Turning Stone Counseling and your insurance company have agreed upon – it’s often reduced by $20-75 depending on the insurance company.
- It does help when you need to receive medications and/or more intensive services. Most of us cannot afford out of pocket expenses that come with many medications and/or inpatient services.
- Parity Law was passed in 2008 – This law requires insurance to view mental health and addiction services similar to receiving other medical care; therefore its atypical for an insurance company to consider our services specialty services making it a lower out of pocket expense.
Here is a list of Con’s for you to think about if you use your insurance.
- You must have a diagnosis that can be billed to your insurance company. Therefore this is part of your legal medical record. This is so important! Take some time to read up on how this may affect things like obtaining life insurance, certain job.
- Insurance companies can dictate how long you are to be seen. Now this is not explicit but we have certainly worked with companies who restrict our sessions to under 52 minutes. That does not seem like a big deal but for some those extra 5-7 minutes can do wonders for the work being done in session.
- There may be a Cap on services. This is less frequent over the years but does still exist on certain plans. Another reason to know your benefits.
- A provider can terminate at any time and then no longer take your insurance (they do have to typically provide 90-120 days notice and offer to refer you). Unfortunately this can happen for many reasons- mostly we see this because the reimbursement rate is insufficient.
- Insurance companies can access your records AND they can find that you do not need services any longer. A therapist has to reflect in their notes that you meet a certain criteria for that particular service (including how long that service lasts) .
- Specialization: Insurance can and does restrict against certain types of therapy. If you are looking for someone who specializes then you need to know what your insurance plan will/will not cover.
Other Things to Consider
When we talk about understanding your benefits, here is a list of questions I normally have my clients find out.
- When does my plan start and stop. This is important in the event that your company changes plans, your out of pocket expenses will change, etc.
- Are there any exclusions? An exclusion could be they don’t cover family therapy or they don’t cover ADHD. (Yes – insurances can do this). We also see a lot of exclusions for ABA services (we don’t provide this at Turning Stone Counseling) which is used alot for Autism; testing exclusions and certain types of therapy like Neurofeedback, TMS, etc.
- Are there any restrictions on services provided and/or how long? Many times insurances reflect the same sentiment which is “it’s based on medical necessity”- this just means that they want the documentation to reflect why we are doing what we are doing.
- Do you have more than one insurance? If Yes- know that many practices will not do secondary billing. First off – it’s truly a pain. Unlike a medical practice, mental health practices don’t have the time or staff to research who’s primary or waiting for the claim to be paid out by the first plan then bill the second one. Be prepared to pay the out of pocket expense up front and then ask for a superbill so you can submit it for the secondary reimbursement.
- Do you have Out of Network (ONN) benefits? So important to ask this- for many reasons if the practice you are going to no longer accepts your insurance you have that option to now do ONN. If its recommended that you receive additional services- this can be helpful.
- If I am using my FSA or HSA card- can I get a statement? Absolutely- if you need a statement, every practice’s accounting software should be able to provide you with this document to submit.
- What’s a Superbill? – This form is basically an invoice for your services but it includes important information that you can use to be reimbursed by your insurance plan.
Let us know if we can help you in any way as you navigate insurance.
Check us out at www.turningstonecounseling.com
Choosing a Therapist can be really difficult, time consuming, and can lead to you throwing in the towel and settling. Here is a list of 8 Things to Consider while you’re exploring your options.
- Are they Available when you are Available?
- Therapists have specific availability and it’s important to make sure that you find someone who can fit within your schedule. No matter how good a therapist is or how strongly they come recommended, if it’s not going to work with your schedule, you probably won’t stay consistent.
- A suggestion we have is to jot down 2-3 super convenient times for you. Additionally, jot down 1-2 ‘OK’ times for yourself. This gives you some leeway to finding a therapists schedule that will set the stage to be the best fit for you.
- It doesn’t matter how good someone is, if driving to them may get old or too stressful or you find you can never make it on time- It may not be the best place for you.
- A suggestion would be to google their address along with any commuting paths to see what it would really take to get there. Then ask yourself: is it feasible?
3. Know What and Why you’re seeking Counseling at this time:
- Even if you are having a hard time articulating what exactly you are struggling with, just take down some notes of what got you to this point. Remember a therapist’s job is to help you figure the next steps out.
- This will help set the stage for finding a therapist who can work with what you bring to the table.
4. Research, Research, Research!
- Not all Therapists are alike. Many are not trained in the same way or have the additional training it may take to work with everyone’s problem areas.
- A suggestion we have is to ask around, talk to others, ask the school, check in on social media. It can be surprising who recommends who and why.
5. Piggy Backing on #3- Every therapist has a unique style!
- It’s so important to have a general idea of what works for you and what does not. Are you a sensitive person? Maybe not as social as others? Or maybe you really love to talk? Knowing this can really help you narrow down what you may like in a therapist.
- A suggestion we have is to jot down things about someone that you wouldn’t like, then make a couple notes about yourself. When you’re doing the research from #3 ask about those things, i.e. Is that therapist passive? Do you feel heard?
- Many practices will offer an opportunity to have an in-person or over the phone consultation. It may not always be marketed on their website but you can always ask to speak to the potential therapist for a couple minutes. For some this is just enough time to really feel like you could connect with this person on a deeper level.
7. Using Insurance:
- Know your Mental Health Benefits. It’s not uncommon for insurances to have limitations or different financial stipulations for mental health benefits. And some don’t have them at all (Crazy…I know!). Stay tuned for more information about insurances in a later post.
- Double check that not only the practice but the specific therapist you want to see is in network with your insurance. Many times therapists have worked other places or are working at two places so they may see clients with your insurance in one place but not the other.
- Certain times of the year people change jobs or jobs change insurances. You may be thinking well I’ll just get started with this therapist and if it changes we will cross that bridge then. In theory, it’s great that you stay focused on the present BUT so many times this can be very damaging in your work. Know if the therapist takes other insurances and if not, do they take Out of Network and what is their out of pocket rate. Prepare, Prepare, Prepare!
8. Finances and Frequency:
- I added this because many times we aren’t prepared for the out of pocket costs that come with receiving therapy. Deductibles, Co-payments, Co-insurances add up. And if you’re Self Pay, meaning you pay out of pocket for all expenses, ouch! Know if the practice and/or therapist has an unspoken requirement to being seen (we won’t get into ethics here but this occurs a lot in practices). Here at Turning Stone Counseling we believe that assessing your needs at each session is best practice, therefore if need more (say risk issues or severe depression) then we will have that conversation with you; maybe you need less and that’s OK too.
- A suggestion would be to ask about required frequency prior to committing.
We hope this was helpful! Check us out at www.TurningStoneCounseling.com!
You may be wondering how are massages and counseling similar? In all my years of doing therapy I never connected the two but they are very similar.
About a year ago I started to commit to getting a monthly massage from one of those membership places that I won’t name. Who doesn’t love a massage, right? This was going to be one of my self care rituals that I did just for me.
I know I was going because let’s face it I sit all day and needed something to help with the muscle tension in my neck and shoulders. This was going to be incredibly helpful.
What came up for me in the process…
As I committed myself to this monthly practice, I needed to get clear on what the purpose was for me. There are many uses for a massage and I knew I had problem areas but I also wanted to relax in the process.
I figured that my measurement for success was going to be a little bit of relaxation with a little bit of muscle soreness from working out all my knots. What’s that old saying ‘no pain no gain’, I thought I would feel a little pain afterwards because she was doing good work on my back.
My first therapist provided me with that ‘ok’ feeling…I didn’t notice a whole lot of relief nor did I notice muscle soreness due to some big knot being worked out. I was definitely relaxed during the process so at least I was accomplishing one of my goals.
I’d be lying if I said that I never thought about all the money it costs to see a massage therapist. I really wanted to reap the benefits and achieve my goals. But I didn’t know how to ask.
Knowing My Why and Asking for What I Need
That’s when I began to connect how similar the process is between seeing a massage therapist and seeing a mental health counselor. In part, I was going through exactly what my clients go through when they start the process of seeking therapy.
At some point I knew that I would have to ask for what I needed and work through all of the uncomfortable feelings that come up when trying to get my needs met. I believe I laughed at myself several times for how similar this process really is to what I provide to my clients and how much I didn’t want to do that work.
See I liked the person I had been seeing for the past couple of months. She was nice, friendly, and I felt like she heard me when I complained about my body aches.
But I needed and wanted more. I was having thoughts ‘that would be rude to just dis her…I wouldn’t want that to happen to me’. ‘I can’t tell her that I don’t feel significant relief after each session…could I?’
I’m going to digress to another part of my experience that was happening co-currently, which is having to be vulnerable. Vulnerability, according to the dictionary is defined as “the state of being open to injury or attack.” No you’re not being attacked or injured (let’s hope) in getting a massage but it’s as vulnerable as it gets exposing your body to a complete stranger.
As a therapist, there are so many parallels between being vulnerable with someone like me in an office where we aren’t touching but you’re sharing so much of you- to having a complete stranger work your muscles out half naked. I still am baffled and amazed at how vulnerable this process really is.
It takes a lot of work to get to a place where you can feel that closeness as well as feel safe to put your thoughts out there and hope you won’t be judged or scrutinized. How similar that feeling is to having a massage therapist work on your problem areas session after session.
As a therapist myself, I know that taking those risks and getting uncomfortable is what helps me and others grow- I’m a WIP (Work in Progress). I invite and encourage you to work towards sitting with uncomfortable in your journey- it is one of the best ways to grow.
Knowing What You Need & Asking For It
One of the last things I do in my first session with a client is to ask if they feel it’s a good fit for them. I’m basically asking them do they think I will help them get their needs met.
When I ask this I am truly looking for honesty but I know in the back of my head that some people are not quite ready to say – ‘Yeah that’s a hard no for me’. That takes courage in the first session and many times it was hard enough to get to that first appointment, so the thought of going back to the drawing board just seems like more work.
In my process I decided that it was time I was clear with what I needed. I needed her to up the pressure and focus on those knots in my back. I actually had to talk myself through this a couple times.
Guess what happened next! I received a call the week before my appointment that she was no longer there and I had to pick a new person. I have to admit there was a part of me that was relieved and a part that was frustrated because I now needed to have that conversation with this new person.
I have to say I don’t know what was harder, changing therapists, being vulnerable, or asking for what I need. Change is inevitable and most of us know this sub-consciously; but when it happens boy does it mess with you.
Moving on to the next therapist I felt she was really cool and seemed to really understand the body. I told her from the beginning what my goals were and how much pressure I could handle.
Well wouldn’t you know it. Her pressure left me crying most months. I felt super confused with what to do at first but then realized that I just needed to communicate this to her. It wasn’t easy but she heard me and was able to meet my needs.
I went through one more person who was incredible but she left to go to law school before finding my current person. Each session, I work hard on asking for what I need and communicating what’s working and what’s not, as well as sitting with being vulnerable.
Remember that it takes courage to work towards your needs. You can do it and don’t give up trying.
- Know Your Why? What are you looking to get from the experience? What do you need? And how do you ask for that? Finding someone who is open to collaborate with you on this is essential.
- Vulnerability is a normal part of the process. Growth comes from being vulnerable and uncomfortable. It won’t be easy but in the end you will be that much closer to your goals.
- Change can come at any time in the process. It’s uncomfortable and difficult. It will make you want to give up but Change can help us grow too!
Check us out at www.turningstonecounseling.com!