If You Choose to Access Insurance

There are a number of issues to weigh carefully if you are considering accessing insurance. I’ll outline them for you here and would be happy to talk with you further to answer your questions.

Accessing Insurance: Issues to Consider

  • Insurance coverage is limited to 45-minute sessions that must take place in the office.  Utilizing flexible session lengths and technology that can really accelerate your progress, such as telephone or video conferencing and working online, is not covered by insurance.
  • Insurance coverage is often limited by the insurer’s definition of “medical necessity” to short-term weekly sessions.
  • In order to file an insurance claim, a diagnosis is required and must be conveyed to the insurance company.  This diagnosis remains a part of your medical record and may be included in the national database of the Medical Information Bureau, an entity that allows insurance companies to share information.  Besides the obvious privacy concerns, a mental health diagnosis can affect your ability to obtain affordable coverage.
  • The medical model of providing a diagnosis is not always in clients’ best interest.  Please read more about How a Diagnosis Can Hurt here.

These limitations can get in the way of doing what it takes to help you feel better and enjoy your life.  When possible, I recommend a much more comprehensive, multi-modal approach tailored to your precise preferences and needs.  You can read more about this approach here.  This approach cannot be billed to your insurance, although it may be allowable as a medical deduction for tax purposes.

Know your coverage

If you make a choice to utilize your insurance benefits, it’s essential to fully understand your policy. Insurance coverage is an ever-changing thing. There’s only one way to know definitively if your insurance company will cover your sessions – and that is to contact the company and inquire. I am happy to assist you in this process.

The information that you will want from your insurance company is:

  • Provider list
  • Information about both in-network
    and out-of-network benefits, including:
    – Co-pay and co-insurance
    – Whether a pre-certification or authorization is required
    – Deductible
    – Number of sessions allowed

I am currently contracted with the companies below that manage Behavioral Health Services for a number of health insurance companies.  Because this list is constantly changing, it’s worth checking if you do not see your insurance company listed.

  • HealthSpan
  • Magellan
  • American Psych Systems,
    specifically the Employee Assistance Program (EAP)
  • LifeSynch which manages behavioral health services for some Humana policies
  • Great-West Insurance
  • Bureau of Workers Compensation
  • Aetna
  • UC Health Preferred
  • UC Health – University of Cincinnati Physicians (UCP 250, UCP 1000, UCP 3000)

Having an understanding of fees and insurance coverage is a crucial in order for you to be able to comfortably begin therapy and focus on the issues that you want to resolve. Please don’t hesitate to ask for help.