Q&A About Mental Health & Insurance

After I wrote THIS BLOG POST, I was asked several questions so I thought I’d address them here.

QUESTION: Do people get disappointed because you don’t take insurance? Do you lose clients because of that?

ANSWER: it is very common for potential clients to ask if I accept insurance and yes, they seem disappointed.. until I explain why. I share this because I feel it is very important for people to make informed decisions about their treatment. 

QUESTION: Is this all controlled by the AMA and the MHPAEA?

ANSWER: You already know my feelings about the American Medical Association (AMA), but I haven’t written yet about how the Mental Health Parity Law of 1999 (MHPAEA) requires that insurers cover specific severe mental health diagnoses to the same extent they cover medical conditions.

This translates to more coverage and comprehensive benefits to the following severe mental illnesses:

 Anorexia and bulimia
 Bipolar disorder
 Major depressive disorders
 Panic disorders
 Schizoaffective disorder
 Schizophrenia

The MHPAEA of July 1, 2010, mandates mental health benefits to be equal to medical coverage provided by the plan. This covers most plans and requires equal coverage for all mental health and substance abuse diagnoses covered by the plan. However, this law does not apply to individual or small business plans (employers with less than 50 employees). This too allows insurers to limit coverage based on insurances’ definition of medical necessity, and plans to manage therapy visits, authorizing a few sessions at a time.

QUESTION: If I use insurance, who can treat me and how do the PPO, HMO, and even the POS plan affect my choices?

ANSWER: You can choose a therapist from the “Preferred Provider” or in-network list of your health insurance company or you can choose an out-of-network therapist. The reimbursement rate is usually higher if you choose from those preferred by the insurance and will be lower if you choose an out-of-network provider. PPO plans tend to reimburse based usual & customary fees, but the insurance plan determines what fee is “usual & customary” and generally not representative of actual psychotherapy fees. With HMO Plans you are required to choose a provider who is on your insurance network. Since most skilled, successful therapists don’t take insurance or limit their participation, finding an effective one for you may require some effort on your part. Be sure to check how many sessions are covered by your plan and at what co-pay to make sure that using your insurance feels right to you; weigh the actual financial benefit against the downsides of compromising your privacy, a coverage that may not meet your treatment needs, and restricting your choice of providers.

QUESTION: If you don’t accept insurance, what options do I have?

ANSWER: We understand and that’s why we offer a payment plan that is convenient for you!

QUESTION: What do you see as the future for mental health? 

ANSWER: I believe in therapy, but not the non-traditional kind nearly as much. The non-traditional kind is the AMA and APA model. The true non-traditional therapy is what people today call ‘traditional’ but it’s not. Not even close, but more on that in a separate post. 

Whether you choose ‘traditional’ (really, non-traditional) or ‘non-traditional’ (really, traditional) therapy, I always recommend paying cash whenever possible. If you pay cash, nobody has to know that you are seeking assistance with mental health concerns. Plus, there is no public record of it either and no requirement for you to be diagnoses – er, labeled for life. 

As for the ‘future’ – well, since approximately early 2014, managed care has gotten worse and insurance companies are even dropping their members or decreasing coverage for the ones they choose to keep. Less people have mental health coverage looped into their policy anyway and I suspect that decline to continue – and I hope it does. I also believe that more requirements should be placed on the care providers to work on their clients behalf instead of working to support Big Pharma.

Overall, I am very grateful to be able to offer the ADNA program for over 30 years now and I am able to stay away for the AMA cartel.