I encourage my clients to pay for their own treatment whenever possible. This is the only way to be sure that your privacy will be protected. You cannot depend on your insurance company to protect your privacy. Insurance companies routinely exchange your private health information with other insurance companies, and where else the information goes is anybody's guess.
Most people can afford to pay for their own treatment with me, because I discount my fee for self paying clients from $85 per hour to $75 per hour. Many health insurance companies require copayments of $25 or more per visit anyway. The most important reason to pay for your own treatment is that you retain control over critical treatment decisions. When the insurance company is paying, the insurance company decides what your treatment goals ought to be and when treatment ought to conclude. Some insurance companies try to maintain control over referrals to other doctors, questions of disability, or even absence excuses from work.
Most health insurance, though not all, provides for at least some psychotherapy benefits. I am able to bill most health insurance companies, though not all.
Some insurance plans restrict participation to their own staff, or a very short list of doctors, who have agreed to keep treatment treatment extremely brief, in order to save the insurance company money.
Health insurance companies I routinely do business with include the following:
- Blue Shield and Blue Cross HMO and PPO, including Prudent Buyer
- Aetna Health Plan
- Health Plan of San Joaquin (for San Joaquin County employees)
- San Joaquin County Employee Assistance Plan
- Managed Health Network (Includes HealthNet)
- United Behavioral Health (Includes U.S. Behavioral Health and related companies)
- Some other miscellaneous health insurance plans
Some of these plans require me to collect a copayment (also known as share-of-cost), while others require a zero copayment.
Typical copayments are $5 to $25, but some of my clients pay copayments as large as $40. Some make you responsible for an annual deductible against your major medical benefit. (This is often $100, but not always.)
Some of these plans have very limited counseling benefits, while others have fairly generous benefits.
It is often impossible for me to tell you what your mental health benefits are, or how much your copayment or deductible will be, because these vary from employer to employer, within the same plan. If you need to find out what your benefits and copayments will be, you might be able to ask your employer or read your benefits booklet. In some cases, you can find the information on your health insurance card.
In most cases, you will find a toll free number on your insurance identification card. Prepare to be on hold for half an hour or more, and when you finally get through, prepare for clueless personnel. With patience, you'll likely get your questions answered. While you are asking about your benefits and copayments also inquire about authorization procedures.
Many health insurance companies require you to go through an "intake" or "pre-authorization" procedure. In some cases, your primary care doctor must authorize treatment. In other cases, you must talk to a company "case manager" on the telephone. Be patient and kind with your case manager. He or she may be underpaid, undertrained and overworked.
Health insurance companies I CANNOT or WILL NOT do business with include:
- Kaiser Health Plan (they only allow Kaiser doctors)
- Medi-Cal, also known as MedicAid. (Medi-Cal mental health services is now an HMO administered by San Joaquin County, with an exclusive provider list)
Are Your Benefits "Capitated"?
Your counselor or psychiatrist may participate in a "capitated" contract. What this means is that the doctor gets so many cents per month per patient in a certain geographical area to provide all "necessary" treatment. Who decides what is necessary? The doctor decides. This means that the doctor is under economic pressure to provide you with as little treatment as possible. If the doctor provides too much, he or she goes broke. Even doctors who have good intentions will find it difficult to provide you with treatment you might actually need. And a few capitated doctors are just plain greedy. Ask your therapist if he or she is treating you under a capitated plan. Don't be shy; you have a right to know!
I don't participate in any capitated plans, and don't expect I ever will. My clients deserve better.