Insurance… ugh. It sucks to pay for, it sucks to use, it sucks for patients and it sucks for providers. It’s unnecessarily complicated and seems designed to make us all feel dumb and dehumanized. This isn’t a political post, but the entire way our medical system is set up and paid for is just… ugh. I don’t even want to write a post about it, to be honest, but I’m writing this and you should read it because, like it or not, insurance is SO important.
Full disclosure: While I’m currently in the process of getting “paneled” with a limited number of insurance companies, for the most part I currently don’t even take insurance in my practice. Lots of great therapists do, and even if you need to use insurance to pay for it, you deserve (and can get!) an awesome therapist who you really like and connect with. And if you really feel moved to work with me, while I don’t “take insurance”, I can provide you with what’s called a “superbill” and you may be able to get reimbursed by your insurance company anyway. (I mentioned this was frustratingly complicated!)
Let’s break down the why and how of that last paragraph a little more, because it’s an illuminating summation of the whole process, but it needs details.
First, here’s the central problem therapists face: Insurance companies do not like to pay us.
I’ve heard many horror stories where therapists spend hours on the phone with an insurance company that has decided for no good reason to stop paying the therapist, which has resulted in the loss of MONTHS worth of reimbursement (thousands of dollars) for clients they are in the middle of treating. Then they are forced to negotiate a fee with that client, who expected to utilize their insurance when therapy began and will clearly be distressed about the whole situation.
That’s why, when I started my practice, I made a decision to work on a cash basis, even though it makes it harder to find clients. It was just too overwhelming to think about fighting with insurance companies while also getting my business on its feet!
I will emphasize again, though, that it is still possible for people with some types of insurance to utilize any therapist, even one who doesn’t “take insurance”, using a superbill. More on that below!
First, though, let’s start with what types of insurances there are and what each kind means for those seeking therapy. The types are:
–EXCLUSIVE PROVIDER ORGANIZATION (EPO): EPO’s are managed plans where you can only see a therapist who works in the EPO’s network – with this kind of insurance the therapist must be “paneled” with the EPO.
–HEALTH MAINTENANCE ORGANIZATION (HMO): HMO’s are similar to EPO’s in that a therapist must be “paneled” with the HMO for you to utilize the insurance. HMO’s are also typically limited to a specific given region.
–POINT OF SERVICE (POS): POS insurance encourages you to utilize doctors in their network, but you may be able to get a referral from a primary care provider to see a specialist out of network. POS insurance may be used to see a therapist that does not take that insurance but they will likely cover more if you work with a “paneled” therapist.
–PREFERRED PROVIDER ORGANIZATION (PPO): PPOs allow you to see whoever you want! I work with PPO’s in my practice regularly, but again–a PPO will pay out more to a provider who is “paneled” than one that is not, depending on the details of the specific plan.
If you have an EPO, HMO, or POS your best bet to use your insurance is to get a therapist who is “paneled” with your insurance company. You can find out who those therapists are by either: 1) Going to Psychology Today and using the filter to see who takes your insurance or 2) You can reach out to your insurance directly to get a list of referrals. From there you can review my “How To Find A Therapist” post to see how best to select from the list.
If you have a PPO, the therapist pool your insurance company will pay for opens way up. This is where we get to the idea of the “superbill” that I mentioned earlier. Here’s how it works: You will pay the fee established by a therapist. Then, the therapist will provide you with a document called a superbill. You submit this document to your PPO-provider, and then the insurance company will reimburse you directly some percentage of the fee you paid to the therapist.
Now you may reasonably be thinking: Some percentage??? What the heck does that mean?! (I believe I mentioned dealing with insurance was frustrating for everyone involved!)
Every PPO plan has its own guidelines. Some will reimburse 80% and others will only reimburse $50. There is a simple way to find out. Call your PPO and ask the following question in these exact words:
How much do you reimburse for out of network, outpatient psychotherapy?
They will give you the percentage or number, and then you can make a better decision from there. Do keep in mind though, that typically reimbursement will not kick in until you have worked your way through your deductible amount.
Your deductible should be printed on your insurance card, but you can also ask them directly when you call to ask about the reimbursement rates. It’s important to understand that even with a PPO, you will be responsible for the full therapy fee until that deductible number is reached in total for the year.
I hope this post has provided you with some clarity around utilizing insurance for psychotherapy. Remember, therapy is for and about you, and part of that is engaging with therapy services that you can reasonably afford on an ongoing basis. As annoying as it is, this is important stuff and you deserve to know and understand it.
Doctor Ducky Psychotherapy 