Thoughts on billing insurance for counseling/(mental health) therapy

[JustMe]

I am looking into some counseling/therapy for myself. I have insurance, but since I may want to do some of my own private practice sometime in the near future I worry about trying to purchase individual insurance if I have too much therapy under my current employer-paid insurance. I know (and hope!) that things may change with the current health care changes, but is that a done deal? I did use 8 sessions of therapy for family counseling with my daughter, so I am leary of adding more.

It would not be easy for me to pay for sessions, but should I try to do a sliding scale so as not to worry about not being able to find decent insurance in the future...or should I feel assured that this won't be a big issue given the upcoming health care changes...or should I just know it may be a problem and worry about that later (not my favorite choice)?

Thanks!

[C99]

Does your employer offer an EAP? The way an EAP works is that you get up to 8 sessions (or whatever is in your plan - sometimes it's 3 or 5) per member, per year, PER ISSUE. So if you did 8 sessions of family therapy for your daughter through your EAP, it counts first under her as separate member (since she's a dependent) and if not that, it's likely a separate issue from whatever you'd want to pursue in therapy in your sessions.

If you are referring to mental health parity, that basically means that your employer or plan cannot deny mental health coverage, if it's offered as part of your health plan, simply on cost alone. If your employer would cover $250 worth of tests or treatment for a medical issue, they must also cover $250 worth of tests or treatment for a behavioral/mental health issue, *if they also offer behavioral health coverage.* At least, that is my understanding of them. Mental health parity is a done deal. Not sure what else to which you are referring in your post.

BTW, my understanding of therapy is not that it's traceable or trackable for any reason. I know that with an EAP, you do not have to give your name or any of your information to get therapy, and they do not transmit any PHI to your employer anyway. So if you are using your EAP for counseling, your employer only knows that an employee is using the service -- not which employee is using it.

HTH.

[JustMe]

Thanks for the response. We have an EAP, but the therapist choice is really limited and I have not had good experiences. I tried this route already for this issue, and it was awful. I have used the EAP in previous jobs, when we worked with a different EAP company, and it was very useful. In any case, its not a good option for me right now.

I was not referring to mental health parity, as that is more about group plans. I meant that I may want/need to pay for an individual plan for myself (if I become self-employed) in the future. Therapy is traceable when billed thru insurance that is not EAP, and my concern is that this would really raise my premiums if I need to get an individual plan. Hope that makes sense.

[egoldber]

I know what you mean. I have had this concern about seeking therapy for Sarah because she already has asthma and an anxiety diagnosis on top of it it likely to make her uninsurable in the private market.

But I think right now you can only do what you can do. In your case, since you anticipate making changes in your employment situation soon, I might err on the side of self-pay and sliding fee scale. The health care reforms (not a done deal yet since the Senate and House still need to reconcile) are likely to be phased in over several years, so it may not help you right away anyway. Also I have found that so many mental health providers don't even take insurance that it is barely worth having it.

[cvanbrunt]

I don't know where you live or if this is even an option but is there a university nearby? Check and see if there is a clinical training program (I am totally biased and would only be comfortable with PhD students in clinical psychology) in the psychology department. They will run a clinic that works on a sliding fee scale.

[C99]

Thanks for the response. We have an EAP, but the therapist choice is really limited and I have not had good experiences. I tried this route already for this issue, and it was awful. I have used the EAP in previous jobs, when we worked with a different EAP company, and it was very useful. In any case, its not a good option for me right now.

You can always ask your EAP if they'd be willing to add a therapist you like. It's worth a shot. I work for an EAP (not a clinician) and I know we do this.

[Melanie]

Honestly, and I don't mean to be a total downer, but we just tried to get private health insurance and it is such a racket, marking up your premiums for the littlest thing or excluding you for things you'd expect to be marked-up for...I'd just get what you need now. You could be unisurable at that time anyway.

For example, my kids have a prescription for a common steroid nose spray. We got it for when they had colds so it would reduce swelling in the passages and allow ears to drain (and thus help AVOID EAR INFECTIONS and going down that whole road of medical costs). They use it maybe 3-4 times a year AT most. They told us because of THAT we'd have to pay 25% more premium for them. Seriously. My kids who are almost never at the doctor (I think last year it was just once for their check-ups) are a 25% premium. I have a (thankfully) very minorly slipped disc in my back. I see a chiro for it, but did have 1 x-ray and 1 MRI to confirm it (in retrospect not a smart move since it was just weeks before this insurance thing came up!). I've never seen a surgeon for it or other drug-prescribing MD. I do not take any medications for it. I was excluded and uninsurable in the private market!

So, again, I'm not trying to be a downer, I'm just saying to anyone, that I would make use of the benefits that you need now, and not worry about 'saving face' with the insurance companies for the future b/c you just don't know what they will use to screw you over.

[jenandahalf]

It's infuriating isn't it, those of us who are lucky enough to actually have insurance can't even use it for fear it will come back to haunt us later.

[maestramommy]

Dh has some kind of wellness program through work that is available to all family members. It's strictly for mental health and I believe it is separate from our medical insurance. He found out about it from HR.

[C99]

Dh has some kind of wellness program through work that is available to all family members. It's strictly for mental health and I believe it is separate from our medical insurance. He found out about it from HR.

That is an EAP. :)

[maestramommy]

That is an EAP. :)

I was kinda wonderin':p

[HannaAddict]

I would use your insurance since you will not be able to truthfully answer a private, individual insurance application and just leave off mental health care or therapy if you have received it. They will ask about it and if they ever find out that you didn't tell the truth, and they have well compensated departments to research this, they can deny any and all claims you have had for other things. For example, say you leave it off, get insurance and have a major illness or hospitalization (or not so major, two days I spent recently was billed at $12,000 just for the room!), they will start looking for reasons not to pay and not telling the truth can let them deny you for the totally unrelated health care expense. It is brutal. I don't know if the "reform" will really help and when the exclusion for pre-existing conditions will kick in, but I know the lobbyists have spent tons of money to preserve their business model at the publics' expense.

Good luck and hang in there.

[JustMe]

Thanks everyone for the replies! You have given me a lot to think about.