|Information About Using Your Health Insurance
If you are employed in Massachusetts, state law requires that your insurance provide some mental health coverage. The state-sponsored health care plan, The Massachusetts Connector, also includes mental health benefits. The amount of coverage varies according to your policy, which you can verify by calling the toll free number on your card. When calling your insurance company it is a good idea to take notes as well as to get the name of the customer representative. Many insurance companies keep a computerized log of your phone call. By keeping track of your calls, you may easily reference a previous call, particularly if the information you later receive is different from what you were told originally. As the policy subscriber, you have the power to appeal decisions if requests for services are rejected. Please note that because guidelines require that services be “medically necessary,” you must be given a diagnosis at the time of your first visit to be included with the claim for payment made to your insurance company.
It is your responsibility to confirm the nature and extent of your coverage, to apprise your therapist if your employer changes insurance policies, to know if visits you make to other mental health professionals (psychiatrists, collaborative therapists) are deducted from the number of approved visits you originally receive. Some plans may significantly limit your selection of mental health providers. Other plans, such as PPO (preferred provider) plans, allow you to see a provider outside of the plan. You may have to pay a deductible before you can start receiving benefits for care. You may also need to get an authorization number from your insurance company before they will cover an initial visit.
Questions to ask your Insurance Company about your Mental Health Coverage:
What is the maximum limit of total outpatient visits for mental health?
Often insurance companies give you a limited number of total sessions per year, typically approving a portion of that amount initially (8-12 are customary). To get sessions beyond the initial 8-12, your therapist may need to share information about your treatment plan, including symptoms, diagnosis, and other reasons you qualify for additional treatment. The insurance company agrees to keep this information confidential, although it does become part of your record in the insurance company’s database. Some people prefer to pay out of pocket for privacy reasons, often using their flexible spending accounts for reimbursement. These accounts, which are usually not subject to state or federal income tax, are offered by some employers to estimate uninsured medical costs in advance. If you have questions about using your insurance for mental health coverage, please ask your therapist before or during your initial session.
What is not covered by my insurance?
Typically services such as court testimony, school visits, telephone and e-mail consultations, written reports, and collaboration with other professionals are not covered by insurance.
When you make an appointment, the therapist reserves a specific time for you. Appointments must be cancelled at least 24 hours in advance (for some therapists 48 hours). You are responsible for full payment of sessions cancelled with insufficient notice as insurance companies do not reimburse for missed appointments.