Sample Questions:

1. Does my plan cover mental health benefits? And how do I find out for my specific plan?

2. Do I need a referral from my primary care physician to a mental health professional

3. Do I need any pre-approval from the insurance company before I see a mental health professional?

4. Do I need to see a mental health professional who is on a list provided by my insurance company (in a "network") or am I free to choose any qualified professional?

5. What benefits do you cover (including treatment settings and medications)?

6. What documentation do I need to provide and what should I keep a list of for reimbursements?

7. Is there a specific list of diagnoses for which services are covered? If so, is my diagnosis one of those covered by my policy?

8. What is my deductible and how do any payments I make for treatment, in-network and out of pocket, apply toward that deductible?

9. What prescription benefit does my policy offer? What are the co-pays for medications? Are there different levels of prescription coverage depending on the specific medication? Do co-payments vary depending on whether the medication is generic or name brand? (For Psychiatrists & Nurse Practitioners)

Session limit

• Insurance companies can limit the number of sessions you are allowed. Because you are not using insurance, you are not limited to a certain duration of treatment.

Confidentiality

• Insurance companies can request access to your treatment plan, progress, and therapy notes. Sometimes having a mental health diagnosis can impact life insurance or future employment.

Diagnosis

• To bill your insurance company, a therapist needs to diagnose you with a mental illness. Any documented mental health treatment filed through your insurance company will go on your medical record. Because you are not using insurance, a therapist does not have to give you a formal diagnosis.

Low reimbursement rates

• Some insurance companies offer low rates for one therapy session hour (technically about 45-55 minutes) in return for listing their practice in their directory of providers and sending the therapists referrals. This is why insurance based therapists are often full for months or longer. Rather than accept a $50-105 reimbursement rate, therapists can charge a cash rate that is substantially higher.

Difficulty in working with insurance companies

• Insurance companies require therapists to jump through a bunch of hoops to get paid. It is common practice for most insurance companies to reject submitted paperwork to delay payments. When they’re not seeing clients, these therapists are spending time on insurance paperwork and resubmitting billing claims in order to get paid, or spending hours on the phone contesting unpaid claims.

Wanting to see fewer clients per week

• Because therapists are paid less by accepting insurance rather than private pay/cash, they must see more clients to make a liveable income. By not accepting insurance, therapists charge more, but can see less clients.

Retroactive Claim Denials

• Insurance companies can audit a therapist’s claims and paperwork for several years back. If they find any mistakes or inconsistencies in the therapist’s paperwork (including grammar, punctuation, margins, etc.) they missed when they originally approved the therapist’s claim, the insurance company will request that the therapist return the fees they were paid.

Click here to read a blog post I wrote .

Please use your best judgment about your therapy needs and unique situation to adapt this email template.

Try to keep it simple and avoid giving too much information.

If you are worried about confidentiality, call instead.

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Subject Line: Seeking Therapy

Hello (clinician name),

My name is [NAME] and I am seeking (FREQUENCY) therapy for (CONCERNS).

I looked over your website including insurance, scheduling, and who you work with and I think we might be a good fit.

Do you have any current availability for (PREFERENCE OF TIME/DATE)?

If not, can you please refer me to other providers who accept (INSURANCE PROVIDER)?

I look forward to hearing from you. Thank you.

Best,

[NAME]

Using in-network therapist providers will save you the most money.

If you use out-of-network (OON) providers you may be responsible for additional costs.

For example, if you have seek therapy with an in-network therapist who usually charges $200, but the allowed plan amount is $130, they can only charge $130. The therapist writes off the other $70.

If you have the same service with an out-of-network therapist, the therapist can bill you the additional $70. If your insurance plan has out-of-network (OON) benefits, it will only cover the allowed amount that they would pay a contracted provider.

However, some folks prefer to work with a therapist who isn't in network or doesn't take insurance.

If your plan includes out-of-network provider coverage, you can submit a request for partial reimbursement of services.

Check your benefit booklet to confirm your plan's coverage.

Click here to learn more about OON benefits

• If your insurance company does not help you or find you a referral, you can file a complaint with the WA State Insurance Commissioner here