How To Check Your Insurance Benefits — Transcription
Hey everyone. Happy Tuesday again! Today I’m going to, to talk about how to check your insurance benefits to utilize your insurance for counseling sessions. So I wanted to do this one because I feel like not enough people realize that their insurance actually covers probably more than you think of your mental health benefits. So I just wanted to kind of give you all a sense of how you can go about contacting your insurance company to check counseling benefits, and what that looks like. And just to make it a little bit easier, because we all know that dealing with insurances are not fun, so just want to help that process out a little bit.
So the first thing you might do is call or a lot of insurances now have online portals where you can chat people. So call our chat them and ask them to verify what your behavioral health outpatient benefits are. It’s important that you say outpatient because inpatient typically is going to be a lot more of a headache. And most of the time, you’re not looking for that. If you are going inpatient, usually they check that for you. So behavioral health and it’s going to be outpatient. And typically the location would be in an office, but I know right now we’re doing telehealth. So you can also ask what your telehealth benefits are.
And then they’re going to give you information. They’re going to let you know if you have a deductible, which basically means that you have to meet a certain requirement before they start paying out. For example, let’s say that you have a $400 deductible that usually restarts in the beginning of the year – for a lot of people’s deductibles just restarted. And if you have $400 deductible, and then you pay that. So now let’s say you have a couple of sessions and the deductible is paid. Then you find out what you would owe after that deductible. So they’ll usually tell you that you have maybe a 10% co-insurance, which means that the insurance company will pay out 90% of the counselor’s contracted rate and you would be responsible for the remaining 10%. And then if you have a copay rather than a co-insurance then you would have a flat rate. So let’s say it’s $25 per session. Then you would have a $25 copay after your deductible is met. So if you have a deductible and a copay, you’re not going to be paying the deductible as well as the co-pay – the deductible is first. And then you pay either the co-pay or co-insurance and of course every plan is different. So make sure you verify this is correct, but that’s typically what happens.
So that’s kind of how you would check it and what that means. Now, a lot of places will have some sort of out-of-pocket maximum. So that just means like, if your out of pocket maximum is $3,000 and if you’re ever paying up to $3,000, in terms of copays, deductibles, co-insurance – things like that – then the insurer would pay out usually a hundred percent if you exceed this out-of-pocket maximum.
Now, if for some reason with your insurance, your deductible is super high and you just realize, like, I can’t afford paying the contracted rate, talk to the therapist to see what the contracted rate is. This will help you understand how much you would be paying for sessions. Some therapists will have you come by weekly in the beginning until you can kind of get a better sense of meeting your deductible. You can also opt out of using your insurance and some therapists will offer a sliding scale.
So the Therapist might lower their rate for you if it’s applicable to you and they’ll offer you that sliding scale, and then you’re just choosing to not use your insurance. So the important thing here is to know that if you are choosing to opt out of your insurance, that means that the Therapist will not be submitting claims to your insurance. And you cannot do that either. So it’s agreeing on a rate and choosing that insurance is not going to be used at all. A lot of therapists have you sign paperwork saying that you’re choosing to opt out so they will not be billing your insurance. This is important to know as well, but again, if you’re looking for something where you know you can’t afford a full rate or you can’t afford your deductible, talk with Therapist to see if they can help you out, or if they can work with you on a better rate.
And if you absolutely need something that’s lower again, I know I’ve mentioned this resource before, but “Open Path Collective” is a great resource. They offer sliding scale slots as low as $30 and as high as $60. Typically that’s for couples counseling and you can find therapists in your area. You can read up on their bios and you pay a one-time fee. I think it’s $55 if I’m not mistaken, but don’t quote me on that. And that’s a one-time lifetime fee to be a part of their network. And then you get to reach out to the therapist and find which one that you feel like would be a good fit and work on the rate with them. Again, lowest would be $30, highest would be $60. So that is again, choosing to not use your insurance for whatever reason that may be, or maybe you just don’t have insurance.
I know insurance can be a mess to deal with and can be very confusing. If worse comes to worst, always ask the Therapist before you get set up, if they can possibly help you track the benefits. Most therapists do, I typically will check before each client is scheduled anyways. Just so they’re aware of what’s going on and how much they’ll owe. And unfortunately it’s not always correct when you check, but typically it is correct. But if you have any questions, feel free to reach out to your Therapist or potential Therapist and just ask them if they can maybe double check for you or ask them to clarify if you have any questions So have a good rest of your week and I will talk to you all next week!