Are You Sure Your Insurance Will Cover Your Therapy

The first question many people ask me is “do you accept my insurance?” If I say for example, “yes I do accept Blue Cross Blue Shield of Illinois,”  then I’m asked “when can I see you?”.

It’s understandable that we want to use our insurance when we can. However I  advise potential clients to talk with their insurance carrier and ask exactly what their coverage is. “I know I get 20 sessions a year and my co-payment is always $20.00 to see the doctor.” When I inform them that mental health benefits may be different, they are surprised. While some people are annoyed that I am not immediately trying to get them in, more often potential clients are grateful to have learned what their coverage actually is.

It’s common for a client to call me back and say “I had no idea I had a deducible for mental health.” They are surprised when they have a higher co-pay than they do for other medical expenses. Most people assume the 20 sessions they receive with their coverage is theirs to use when and how they need to.

I educate them that in order for the insurance company to pay for therapy, I need to give them a diagnosis or prove medical necessity. This is why marital counseling is rarely covered.  Moreover since the insurance company is paying for it, they will want an assessment of your work in therapy after approximately 6 sessions before they decide whether to grant you the remaining sessions. “You mean I can’t use my sessions the way I want?”

When I work with clients, I want them to know that using your insurance may appear to be a cost efficient way to get therapy, but you will pay a price in other ways.