Navigating Mental Health Coverage
Money Geek asks for my expert advice on the complicated process of using insurance for therapy and how to choose the right therapist for you.
Read the full article here or my contributions below:
Expert Advice on Accessing and Navigating Mental Health Services
Indigo Stray Conger, LMFT, AASECT CST
What are some common misconceptions about mental health coverage?
It's a common misconception that if your insurance provider offers mental health coverage, you can see a therapist free of charge or with a low co-pay for as long as is deemed necessary by your therapist. In actuality, there are a number of hurdles patients have to overcome to receive coverage for mental health care, including:
Finding an in-network therapist: Insurance companies frequently don’t offer a list of providers in your area, leaving it up to you to contact therapists and ask if they accept your insurance. If your insurance does have a ZIP code-based list, it often includes providers who are no longer accepting new patients or who no longer accept your insurance. Additionally, in-network therapists often have long waitlists and limited office hours.
Choosing an out-of-network therapist: Many therapists don’t accept insurance since insurance companies do not fairly compensate their therapy providers at industry standard rates. You can submit an out-of-network claim for therapy, but how much will you actually pay? Your insurance company may state that they cover 60% of out-of-network mental health care costs. Often, that means that your insurance company will reimburse 60% of the $60 they would pay a provider, not 60% of the $200 your provider charges, leaving you with most of the bill.
Requiring a diagnosis: Once you find a provider, you may need several sessions with your therapist to determine an accurate mental health diagnosis; only some diagnoses will be covered under your insurance plan. Your insurance company will not provide you with a list of what conditions are covered prior to seeking care. Although common mental health conditions, such as depression, are typically approved, they may only be covered under certain diagnostic criteria. For example, depression might only be covered under the diagnosis of Major Depressive Disorder, which meets certain standards for duration and severity, and not Recurrent Brief Depressive Disorder. You may not know if your sessions are covered until multiple appointments have already occurred, and your initial claim has been processed.
Limited amount of sessions: If you meet the diagnostic criteria for a covered mental health disorder, your insurance provider will likely limit the number of sessions per year that are covered. This amount is typically low (between 6-20 sessions) and insufficient to cover ongoing weekly treatment.
Meeting your deductible: Before your insurance coverage kicks in, you may need to pay your plan’s deductible. Some deductibles are quite high, meaning you’ll need to pay thousands of dollars before your insurance company starts reimbursing you or your therapist.
What should people keep in mind when trying to choose the right mental health professional?
Keeping the following in mind can help you find the right mental health professional for your needs:
Personal recommendations: More than with doctors or dentists, patients tend to pick therapists based on the personal recommendations of friends and family. When someone you trust has had a positive counseling experience with a therapist, that therapist is more likely to be a good match. Also, since your family and friends know your personal style, they can steer you toward a therapist that is more likely to connect with you. The therapeutic alliance, which is the professional connection you feel with your therapist, is generally regarded as one of the most important parts of successful counseling. It is imperative that you feel heard, seen and accepted from the first time that you meet.
Don’t go on one recommendation alone: Get three to five recommendations, if possible, and then look at each therapist’s website and get a feel for them. Many therapists have blogs in addition to their profiles so that you have a chance to know what they’re all about. Counseling is largely centered around personal values. Although a good therapist can meet you where you’re at, regardless of their own personal beliefs, it can be helpful to see a therapist that already understands the world you live in.
Consider education and experience level: You may be tempted to go with a therapist that has half the rate as the other ones you’ve been considering and seems perfectly nice. However, you will get more for your time and money if you see someone that has been practicing for a while. Most of how therapists learn is by doing the work, so it takes a few years to be their most confident and competent selves.
Logistical aspects, such as location and hours: Therapy is most successful if it is consistent and ongoing, which means that making sure you have a certain level of convenience is more important than it is with your primary care doctor, who most people only see a few times a year. Not all therapists offer evening and weekend appointments or virtual care, which can be helpful factors for convenience. Many therapists ask their clients to keep a consistent appointment time on a weekly basis and don’t have much flexibility for changing days or coming in less frequently. Make sure to ask any logistical questions during your new client consultations, so you have all the information you need to pick the right provider.
Schedule consultations: After you have narrowed your list down to two to three therapists, schedule a phone or in-person consultation with each of them. Most therapists offer free consultation sessions. Suppose they don’t, be willing to do a first session without fully committing to working together. Although it can be tempting to go with the first therapist that sounds great, a therapist who seems like a perfect fit might not feel quite right when you meet them.