Tips for using your insurance to pay for therapy
Let’s get it done. And by “it'“ we mean breaking down barriers to affordable therapy
We’re just going to go ahead and say it out loud. Navigating health insurance can be a nightmare. Many people avoid dealing with insurance as much as possible because it can be so confusing. But, you’re paying hefty prices for that insurance policy so you might as well use it to your benefit.
More and more people are using insurance to pay for their mental health treatment. At Shift Counseling, PC, we think this improved access is a very good thing! If you’re struggling with depression, anxiety, trauma, or stress related issues, help is available.
Your best bet for affordable mental health treatment: Finding an in-network provider
Even if your policy provides coverage for mental health services, finding a provider and understanding your benefits can still feel overwhelming. The most direct way to get the information you need to move forward is to call your insurance company. Somewhere on your insurance card, there should be a “customer service” number, that you can call. Yes, you may sit on hold for a while, but someone from the insurance company should be able to provide you with a list of in network providers and explain what your out of pocket costs will be.
There are some great therapist finding websites, such as Therapy search, Psychology Today, Mental Health Match, Latinx Therapy (as well as others) that can help you narrow your search by location, issues, and insurance type.
What types of insurance is Shift Counseling, PC in network with?
Shift Counseling, PC is in network with BCBS PPO, Blue Choice PPO, many Aetna plans, and Cigna/Evernorth.
Hot tip: You may have access to short term counseling benefits available to you through your employer, separate from your insurance plan. These are called EAP (Employee Assistance Program) benefits. You may need to reach out to your HR department to find out if your company offers an EAP program and how to get started. There is usually no out of pocket cost for members using their EAP benefits. Therapists at Shift Counseling, PC are in network with Lyra EAP.
What if I have County Care, Medicaid, Medicare, or a Managed Care version of Medicaid?
Here are some links to the provider lists for these policies:
BCBS Illinois Community Health Plans
Aetna Better Health of Illinois
What if I have “Obamacare” or an ACA policy that I bought through the exhange?
Good news here: The in network provider list for ACA policies is pretty much the same as a regular commercial policy (a policy you get through your employer.)
Hot tip: one affordable BCBS option on the marketplace is MyBluePlus. With this network, you do need to select a primary care provider and get referrals for specialists, but Shift Counseling, PC is an in-network provider with this plan.
We’re helping to solve the mystery of affordable counseling
What is the difference between an HMO and a PPO?
If you have an HMO policy, you will probably have to get a referral from your Primary Care Provider to see any specialist, including a therapist. They will refer you to a therapist who is in network with your HMO. This can be daunting, but it is the most affordable way to get mental health treatment if you have an HMO. Some HMOs provide out of network benefits, but we are seeing this less frequently lately. There seems to be a squeeze on out of network benefits, which sometimes leads to difficulty finding a mental health provider and long wait times if you have an HMO.
If you have a PPO policy, you generally do not need to get a referral for routine outpatient mental health services (such as weekly individual therapy.) There are often more providers who are in network with PPO policies as well. We are seeing a trend of outpatient therapy being covered as an “office visit” so the deductible does not need to be met before insurance starts paying for services. Instead there is often a reasonable copay for each session. Unfortunately, benefits vary WIDELY across different policies, so when in doubt, call your insurance directly to get the most accurate information.
Shift Counseling PC is in network with BCBS PPO, Blue Choice PPO, Aetna PPOs, and Cigna/Evernorth PPOs. We do not participate in any HMO networks.
Hot tip: if you think that you or someone in your family is going to need mental health treatment in the next year, consider choosing a PPO plan at your next Open Enrollment or Qualifying Life Event. Yes, PPO plans have a higher premium, but they may save you time, stress, and money in the long run if there is a need for mental health services.
What is Open Enrollment? Special Enrollment Period? A Qualifying Life Event?
Open Enrollment is when you pick your health insurance plans for the upcoming year (this usually occurs during the Fall.) A Special Enrollment Period is a time outside of the normal window of Open Enrollment when you can sign up for health insurance. A Qualifying Life Event is a change in your personal circumstances that would make you eligible to change your coverage outside of the Open Enrollment period. Hot Tip: Check out the list of Qualifying Life Events if you are stuck with an insurance policy that is not working for you. You may be able to make a change in your coverage mid-year.
We are here to lend a helping hand to those searching for affordable counseling
I found an in-network therapist, but I still don’t think I can afford long term therapy. What should I do?
Even with insurance coverage, depending on your co-pays or co-insurance, sometimes therapy is not truly affordable. If this is the case for you, tell your therapist at the beginning of treatment. We get it! If paying for therapy is causing you major stress, we can try to help you work as efficiently as possible. We can help you set short-term goals based on the number of sessions you can afford. Being this direct might feel weird, but as therapists, we are all for clear communication about boundaries and needs. Managing expectations from the beginning can help you have a positive therapy experience, and that is what we want for all of our clients.
Ok, I have been searching for an in-network therapist and I can’t find anyone who takes my insurance. Help!
Unfortunately we have gotten a lot of calls lately from people who have been searching for an in-network therapist for months. These types of stories are so sad to hear. Here are my top tips for people in this situation:
1: Contact your insurer directly. They have a responsibility to help you out in these types of situations. No one should have to wait months for mental health services. This can be dangerous, and causes unnecessary suffering. Your insurer has an obligation to maintain a robust network of providers who can meet the needs of their members. When an insurer fails to have enough providers, it is called “network insufficiency.”
2: If there is network insufficiency, you can request a “Gap Exception.” This would mean that you can request for an out of network provider be covered as in-network due to lack of in-network providers for a necessary service.
3: If you still can’t get help, see if you are eligible for a Qualifying Life Event to get you out of that policy that is not working for you.
4: At your next Open Enrollment, choose a better insurer or a PPO plan, if possible.
5: If you still can’t find an in network therapist and can’t afford to pay full price out of pocket, check out Open Path Collective, which is a non profit dedicated to helping people find affordable mental health coverage. https://openpathcollective.org
Hot tip: Get an FSA/HSA/HRA account and put money into it to cover out of network therapy if you haven’t been able to find a therapist who takes your insurance.
In the past few years, certain insurance companies (we won’t name names, but they are payers we don’t work with) have been making access to mental health treatment harder by maintaining low reimbursement rates for providers and escalating “administrative harassment"- meaning excessive reviews, requests for more information, and denying claims. As a result of this harassment, many therapists have stopped working with these payers as a means of protecting themselves. If your insurance company is one of these payers, you may have a very hard time finding an in-network therapist.
But, there is a workaround, and that is your FSA/HSA/HRA card. You can use your funds to pay for out of network treatment. Your therapist can give you a “superbill” so to prove that the services are legitimate FSA charge. Most therapists want to make therapy affordable, but we shouldn’t have to be the ones to sacrifice our financial health and sanity to make it happen. We have to take care of ourselves to be able to take care of our clients!
We have therapists who accept insurance and have openings for new clients!
At Shift Counseling, PC, we have therapists who have openings, even for Evenings and Weekends! We do accept some insurance plans and we can help you understand your benefits. Our therapists specialize in providing individual counseling for teens and adults suffering from depression, anxiety, trauma, and stress related issues. Several of our therapists are bilingual (English/Spanish) and are trained in CBT, EMDR, and PolyVagal therapy. Use the link above to view our therapist’s openings and see if we have appointments available that work with your schedule!
