With the advent of the Affordable Care Act (ACA), more people have health insurance benefits, and more of those benefits apply to mental health services. There are several factors to consider when deciding whether to use your insurance to cover your mental health care. The main benefit is financial and it is significant. Many people are not able to pay the full fee out-of-pocket, so having insurance enables them to access mental health care they would otherwise be unable to afford. Please read Take Charge of Your Psychological Care, a brochure released by the Oregon Psychological Association, to learn about your benefits that apply to mental health, your legal rights, and your options for care.
How to Determine Your Insurance Coverage
If you are considering using your health insurance to cover your treatment costs, we will need to determine the following:
- Whether your plan covers outpatient mental health treatment. Most plans do because of the ACA.
- If there is a deductible that must be met before your plan will reimburse for psychotherapy fees, and how much you have left to pay. Note that some plans waive the deductible for outpatient mental health visits.
- The amount that is your responsibility to pay (a copay or coinsurance) for each office visit.
There are several ways to find this information. You may have been sent a member handbook or explanation of benefits, it may be available on your insurance company’s website by logging in and accessing your account information, or you can call a member representative at the number indicated on the back of your insurance card. Since I know how difficult it can be to understand how insurance works, I created a blog post that explains common health insurance terminology.
I am currently an in-network provider for PacificSource, HMA, Bridgespan, Regence and most Blue Cross Blue Shield affiliated companies. As an out-of-network provider, I accept Moda/ODS, Aetna and most other plans. If your plan has out-of-network benefits (or is a PPO), my services will likely be covered because I am a licensed professional. Insurance companies do not reimburse for services rendered by unlicensed professionals in private practice. After you have met your deductible, your insurance company will typically require you to pay a set copay amount or a percentage of the full fee (referred to as coinsurance). Please contact me to discuss the possibility of receiving insurance reimbursement for my services. I am happy to help you navigate this often tricky process in any way that I can.
*I bill insurance companies directly on behalf of my clients with their permission, which makes the billing process less stressful for you.