This article explains my reasoning to be an Out-Of-Network Provider.
I hope you will read
it and be well informed before you use your health insurance to pay for counseling.
One of the things I like about the coaching process is you do not need a
diagnosis for coaching. Consequently,insurance will not cover it.
(Click on this MIB banner to go to one of the biggest insurance information data banks.)
Warning – Little Known (And Nasty) Secrets About Using Mental Health Insurance Benefits
In short, the secret is this: all the information your insurance company collects on you can and will be used against you. Up front, you may get some or most of your mental health costs paid for. However, in exchange, your insurance company collects tons of personal information about you and your family before they pay up. Once that information goes to Internet data banks (and it always does), you have lost control over how that information is used.
Health care insurance companies are not your friends and they are not here to help you. They make huge profits betting against you and your health. They know more about your health than you do. In all likelihood they know more about you than you do their business practices and secrets.
In an effort to do what I can to protect clients, I want you to be informed about behind-the-scenes realities and why I practice as an out-of-network provider.
Perhaps you have paid health insurance premiums for years. You know you have mental health coverage and so for some reason you decide to use it, perhaps to help yourself through a tough time in life. Naturally you feel you deserve to use your insurance benefits and to have your insurance company cover the counseling.
Unfortunately it’s not that simple. Yes, you’ve paid the premiums for years. No, there is much more to do before your benefits can be accessed. First, you must spend time on the phone or the Internet obtaining prior approval for counseling. Insurance companies call this “determining medical necessity.” Otherwise, the counselor you go to will not be paid. You saying you want or need counseling is not enough. Insurance companies want to determine that for themselves. To do this, they will ask you many, personal questions. All that personal information is kept in their data banks and to my knowledge, never deleted.
Assuming you convince the insurance folks you really do need counseling, they will approve a few, usually 2 to 3, initial counseling sessions with a particular counselor who is in their network and has agreed to work for the insurance company at a drastically reduced rate.
The next hurdle comes when you have used up those first approved sessions. If you and your counselor think more sessions would be helpful to you, your counselor will need to spend time on the phone talking to your insurance company about your progress. This conversation will pass more information about you to the insurance company that your counselor has collected in those first sessions. Although discretion may be used by the person at the insurance company collecting the information, anything your counselor knows about you (or your family) is fair game.
If the caseworker at the insurance company agrees that you have continuing medical necessity for more counseling, another set number of sessions will be granted. And so the process goes until you’ve exhausted the annual number of sessions your insurance company has provided on your particular policy. After that, any additional mental health treatment comes out of your pocket.
The risks you run for using insurance benefits for counseling are three: 1) Loss of privacy for you with all of the personal information collected about you and your family. 2) You and your counselor lose control over the counseling process and how long it goes on.
Finally, 3) Information collected about you by your insurance company is shared with any other insurance companies which may need it to make a decision about whether you are insurable for other forms of coverage such as life insurance, disability insurance and in some cases, automobile insurance. You will have a mental health diagnosis following you around for the rest of your life.
Mental health is the most stigmatized aspect of your health. You can have treatment for sexually transmitted infections with coverage from your insurance benefits and it will not stigmatize you like one counseling session on your insurance record. In the long run, it may be worth it to you to get the counseling or coaching you need and pay out-of-pocket rather than use your so called insurance “benefits.”
Keep your personal information private and trust in your confidential rights alive. Don’t work with insurance companies to pay for marriage counseling. Use an Out-Of-Network Provider.
What are the my fees for counseling/consultation and how do they get paid?
My fee for a clinical session is $150.00. The fee is the same regardless of the number of people in the session.
I prefer clients to pay as they go, session by session. At the conclusion of each session, I can provide a detailed receipt that has all the information insurance companies need to reimburse you. All you need do is submit the receipt to your insurance company to activate coverage on an out-of-network basis. I am not part of any HMO or managed care panel of providers, so you may want to contact your insurance company to see what the amount of coverage will be and how to best get the reimbursement process started.
If the pay-as-you-go option doesn’t work for you, I’ll discuss other possibilities with you when we meet. I take credit cards and offer a discount program of up to 25% with advance purchases.
Fees for business consultations are based on a daily rate. Please inquire, Paul W. Anderson, PhD, 843-422-1408.
In the meantime, I remain an out-of-network provider.