A Note About Insurance
An important note about insurance:
Before deciding to utilize your insurance, you should carefully consider the following information.
In order to reimburse or provide payment, insurance companies will at the minimum require a diagnosis and often times also require some sort of collaboration between your therapist and your primary care provider. There are some potential issues with this – one being that a mental health diagnosis will always be a part of your medical record and once it is there, it can be used in the future when you apply for things such as life insurance, disability claims, etc. In addition, many people come to therapy for help with self-improvement, common stressors, and/or relational issues. These clients often do not meet criteria for medical necessity meaning insurance will not pay for their visits.
Another consideration is that utilizing your insurance means that the insurance company, not you or I will be deciding your “necessity” for treatment and they may decline to pay at any time for various reasons or they may limit the number of visits you can use in a certain time frame. This can make it difficult for clients to remain engaged in treatment for the length of time they and I feel is necessary to meet their goals.
Paying for therapy yourself rather than utilizing your insurance can also result in improved compliance, better outcomes, and a greater sense of empowerment.
Finally, insurance providers do not always cover services such as couples, family, and sex therapy.
Good Faith Estimates:
If you are uninsured, or you are insured but you don’t plan to file a claim with your health plan, health care providers must give you a good faith estimate of what their expected charges will be before you get the services.
Providers must give you the good faith estimate:
- For services scheduled at least 3 business days ahead of time, within 1 business day of scheduling the service;
- For services scheduled at least 10 business days ahead of time, within 3 business days of scheduling the service; or
- When you ask for the good faith estimate, within 3 business days of you asking for the estimate.
The good faith estimate will include:
- A description of the service you will be getting;
- A list of other services that are reasonably expected to be provided with the service you are getting;
- The diagnosis and expected service codes; and
- The expected charges for the services.
For more information about good faith estimates, visit the CMS No Surprises Act website.