It’s about choice. Especially when it comes to mental health care. We have become captives of our health plans, thinking that we can only choose from within the network. On the medical side, there are more choices, but not always when you get to specialists. On the mental health side, it gets even more complicated, which is a shame, since most folks seeking therapy, at least initially, are especially fragile and vulnerable.
To be an empowered consumer, you need to be informed. Know your benefits. If you aren’t sure, then call your insurance carrier, and ask questions. Some information you need know:
What is my coverage for mental health, inpatient and outpatient? Does this include family therapy?
What is my coverage for substance abuse and alcoholism treatment, inpatient and outpatient?
What level of therapist is covered: psychiatrist, psychologist, social worker, licensed professional counselor, addictions counselor?
How many sessions per year? Is there a lifetime maximum?
How are biologically based diagnoses covered?
Do I have out of network services to cover a therapist who is not in your network?
What is my deductible for in-network services? Out of network services?
What are my co-pays for in-network services? Out of network services? If it is a percentage, what does that translate into in dollars out of my pocket?
Do the sessions have to be pre-certified or pre-authorized? If so, how do I get more sessions authorized?
Some very good therapists are in the networks. Not all therapist are in all networks. Some are not in any network. It is not easy to pick a therapist. You have more choices than to have to pick a name from a list. Many people prefer to go to someone who has been recommended to them by a friend, co-worker or family member. That therapist may not be in your network, but may be the best fit for you. That’s about choice, and about empowerment. And sometimes, we need to pay a little extra for the choices and empowerment. It is almost always worth it.
