Meagan: 0:28

Today we're talking about something super practical, but also incredibly important. Should you use your insurance to pay for therapy. We'll go over the real pros and cons of using insurance versus paying out of pocket. This is one of the most common questions that we get from clients, and the answer really isn't one size fits all. So whether you're starting your therapy journey or reevaluating how to continue it, let's explore your options together. Let's start with this. Therapy can be life changing, whether you're dealing with a serious mental health condition, or navigating the everyday stressors of life, a breakup, a new job, grief, parenting, trauma, you name it. You don't really need to have a formal diagnosis to benefit from having a therapist who listens, validates, and helps you sort through what you're going through. Let's be honest. As helpful as therapy can be, it's also an investment in your time, energy, and finances. So it's really natural to ask, how do I make therapy affordable without creating even more stress in my life? One option is to use your insurance benefits, but, and it's a big, but that doesn't mean it's the best option for everybody.

1:41

Before we jump into the pros and cons of using insurance for therapy, let's pause for a quick crash course because let's be real. Insurance is confusing, especially when it comes to behavioral health. So here's the simplified breakdown of how insurance typically works when it comes to therapy. Number one, your plan type matters. You might have A-P-P-O-H-M-O or EPO or something else entirely. PPOs usually allow for more flexibility. You can see out of network providers and may still get partial reimbursement if you're working with a therapist that is not credentialed to be part of their network. An HMO often requires you to stay in network and may need a referral from your primary doctor in order to see another provider within that system. If this is the case, always check specifics with your insurance company so that you really know what type of plan you have and what the boundaries of that plan are. Number two is to know about deductibles, copays, and co-insurance. A deductible is the amount that you pay out of pocket each year before your insurance starts covering any medical services and the cost of those services. A copay is a flat fee that you pay per visit. For example, this may be listed on your insurance card as paying$20 per session. Or$35 for an urgent care visit, or$50 for a specialist visit. If this isn't listed on your insurance card and you're not sure what your copay is, or if you have one, that's a great question to call and ask your insurance company. Then we have co-insurance. This is when you pay a percentage of the session fee after meeting your deductible. So even if therapy is a covered service in your plan. It may not be entirely free to you. It really depends on where you are in your deductible cycle. For example, if you have a insurance plan with a thousand dollars deductible and a 10% co-insurance, you will have to pay out of pocket a thousand dollars towards your medical care, including therapy before your insurance company starts to cover any of those costs. Once you have paid that a thousand dollars deductible out of pocket, you still have to pay 10% of any medical costs after that as part of that co-insurance element of your plan. So if you're not quite sure where you land with all of that, what your deductible is, if you have a co-insurance percentage or if you have a copay, these are great questions to call and clarify with your insurance company. as part of the insurance verification process at her time, we also have a great biller on staff who verifies exactly what type of plan you have, what coverage you have, and what is gonna be required from you out of pocket. We will also update you on your deductible amounts and how far you have to go to meet your deductible before your insurance jumps in to help cover the cost of those therapy sessions. The third thing you wanna know about is in network versus out of network. If a provider is in network, this means that your therapist has a contract with your insurance company. If your therapist is out of network, it means that they don't. You might still be eligible for reimbursement after paying out upfront, but that's where super Bills come in, which we'll talk about a little bit later. So whether your ideal therapist is in network or out of network, it means a little bit of different things for how much is going to be required for you to pay out of pocket versus how much your insurance company will come in to help cover the cost, either partially, completely, or not at all. The fourth thing to know about is session limits and pre-authorization. Some insurance plans limit how many therapy sessions you can have per year, or they may even require pre-authorization, basically asking permission in advance to get care. So always ask before starting a new medical treatment such as therapy, are there any session limits or preapprovals required for this behavioral health service? If so, you may need to talk with your primary care physician and get them to give you a referral so your behavioral health sessions are covered by your insurance. lastly, another important thing to know about when it comes to insurance is confidentiality and documentation to get paid, your therapist has to submit documentation to your insurance, including your diagnosis and some detailed notes. We're gonna talk a bit more about this in just a moment, but this is a crucial part of the conversation, when deciding if it's right for you to use insurance. Alright, now that you've got the lay of the land, let's dive into the actual pros and cons of using insurance for therapy and why it works well for some people and not so much for others. Ready? Let's go./

Meagan: 6:34

Let's start by looking at the pros of using insurance to pay for your mental health therapy. First, and maybe most obvious, it reduces your out-of-pocket cost. If your insurance plan includes behavioral health coverage and you've already met your deductible, your sessions may be all or partially covered thanks to something called parity laws. Insurance companies are required to cover mental health conditions similarly to how they cover physical health. Your therapist and our administrative staff at her time therapy are always happy to walk you through what your particular plan covers and what your copay and deductible might be. Sometimes the savings are really significant, especially if you're looking for weekly therapy sessions. Second, insurance can improve consistency in your care. If therapy becomes more affordable through insurance, this usually means you're gonna be able to attend sessions weekly instead of stretching them out to biweekly or once a month. This consistent rhythm helps you make faster progress towards your goals, and it gives your therapist a clear picture of how you're doing from week to week. And third, your copays can help meet your deductible. If therapy is one of many medical expenses that you're managing, using insurance can actually get you closer to meeting your medical deductible, which might save you money in the long run if you have other procedures or medical situations that you're gonna be in later in the year. Now let's take a moment to talk about the cons of using insurance to pay for your therapy sessions. I wanna be really transparent here because these are things people don't often realize until they're really deep into the process. So number one, and this is a biggie, insurance requires a diagnosis. So in order for your therapist to submit a claim to your insurance company and pay for your session, your therapist has to assign you a mental health diagnosis that qualifies for treatment under your plan. So what if you're seeking therapy for something situational like a breakup or a job change? These are very valid reasons for therapy, and unfortunately, they may not meet the criteria for a quote unquote formal mental health disorder. In those cases, therapists often use what we call Z codes, which cover challenges like stress or life transitions, but aren't really considered a pathological mental health disorder. So what's the catch? Insurance won't pay for Z codes, even if they are the most appropriate code to assign you as a diagnosis for what's happening in your life and what you're coming to therapy for. Insurance companies only cover what we call F codes. These are diagnoses, which include disorders like major depressive disorder, generalized anxiety disorder, bipolar disorder are post-traumatic. Stress disorder and so on. The more heavy hitting kind of major disorders that insurance tends to see as meeting medical necessity for therapy. Ethically, therapists can't just give you a more serious diagnosis just to help you get reimbursed and to be able to use your health insurance. So this really puts us and you in a tough position. If your symptoms don't meet clinical thresholds, your insurance won't pay. The second issue with using insurance to pay for your behavioral health sessions is that once you receive a formal diagnosis, if that formal F code diagnosis is appropriate for you, it does become part of your permanent medical record. That means that if you apply for jobs requiring really in-depth background checks, high level security clearance or even things like life insurance, that information and that diagnosis may be accessible to these organizations for these type of life situations. that diagnosis could potentially impact your eligibility or even your rates on things like disability coverage or life insurance. In some legal situations like a divorce or a lawsuit, your mental health records can even be subpoenaed. And what about employees at the insurance company? Let's think about that. Insurance companies can choose to audit therapists at any time and request whatever clinical documentation they want to evaluate if the provider is meeting their requirements to be in network. This means that your treatment plan and the progress notes written by your therapist after every session may be viewed as part of the insurance auditing process by insurance company staff. Third, insurance companies have the ability to limit your care. To some degree, depending on your plan, your insurance company may decide things like how long your sessions can be, how many sessions you're allowed to have within a year or within a certain time period and which treatment modalities they'll reimburse. So for example, if you need a longer session during a crisis, or maybe you wanna explore something like yoga informed trauma therapy or EMDR, which typically, takes a longer session, like a 90 minute session, your insurance might not cover those type of modalities and those type of sessions even though it's what your provider is recommending, it's not what your insurance company has deemed as payable. A fourth issue is that it can be hard to find a therapist who is in network who is actually a good fit for you. This is especially true for clients utilizing Medicare or Medicaid benefits, and we know from research and experience that the therapeutic relationship is the number one predictor of whether therapy works and whether you're gonna get better and reach your goals. So finding the right therapist that is a great fit for you and has the right training and specialty is really tough and it's made even harder if you're wanting to use your insurance benefits and you have to only work with a therapist that is considered in network. Many great therapists either don't accept insurance or aren't paneled yet because the process is incredibly long, arduous, and tedious. Handling with insurance companies takes several months of paperwork and is often so complicated that an outside credentialing specialist is needed to guide that process. That means that the therapist you really click with might be considered out of network because they've simply decided not to put themselves through that process. Lastly, therapists are often paid much less by insurance companies than what they would earn through private pay. It doesn't matter what your therapist charges out of pocket for their private therapy sessions if they are paneled with insurance and you're submitting a claim to have your insurance company pay for your sessions, your insurance company is the one who decides how much your therapist gets paid and reimbursed for that claim, and that rate is often much lower than the amount your therapist really needs to cover in order to pay business expenses and personal expenses. This doesn't really affect you directly, but it also does impact your therapist's sustainability and livelihood, and that in turn affects the kind of care that they can give and how accessible that they are to the people who need them. So that's a lot to consider on the pro side and the con side of using therapy to pay for your behavioral health sessions. you may be wondering is there a third option to just paying out of pocket or using insurance? And the answer is yes. If you're stuck in between using insurance and paying fully out of pocket, there is a middle ground, which is out of network reimbursement. this is how it works. You pay your therapist directly at their out of pocket rate, usually once a month they will provide you with a document that's called a super bill. This looks a lot like an invoice that lists the amount of sessions that you've had during that month and how much you have paid to the therapist and to the practice for the sessions. You then submit that super bill document to your insurance company and request reimbursement for working with an out-of-network provider. depending on your plan, they might reimburse you for all or for part of that out-of-pocket cost. It's not as seamless as using an in-network provider, but it certainly gives you more flexibility to work with the therapist of your choice and the one that is the right match for you. due to the increasing difficulty of working with insurance, both on the client side and the provider side, companies like Mania have started to pop up and exist specifically for this purpose to help you, the therapy client, submit super bills to your insurance and to get reimbursement easier. If you feel that this third option might be right for you and you wanna learn more about it. We recommend visiting manaya.com, and that's spelled M-E-N-T-A-Y a.com, they are one of the biggest and most popular companies right now that are doing great work to help clients get reimbursement easier for those that do have that out of network option within their plan. At the end of the day, using insurance or not is a personal decision. It depends on your financial situation, your goals for therapy, your privacy concerns, and your values. If using insurance is the only way that you'll get the support you need, please use it. Your mental health is more important than a perfect system, and if paying out of pocket gives you more freedom and peace of mind, then that's totally valid too. Just remember, therapy is an investment in you. You live inside your head, in your thoughts, in your emotions, in your past and in your future, day in and day out. Choosing to prioritize your mental health. However you do it is never wasted.

16:09

If you're feeling empowered by today's episode, be sure to subscribe and leave us a review. You can also follow us on social media at her time to talk for more updates and tips. And if you'd like to support the show, consider becoming a patron. If you're ready to take the next step in your mental health journey, visit her time therapy.com and schedule a free consultation with one of our therapists. Thank you for taking the time to talk today. Remember, your story matters. Your voice is powerful, and your mental health is worth prioritizing. Until next time, take care of yourself. This is your time. The information shared on this podcast is not intended to be personal mental health advice, and listening to this podcast does not create a therapeutic relationship between the listener and the therapist featured on this podcast. We encourage listeners to engage with a licensed therapist for personalized mental health treatment and advice.