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Private Insurance and Counseling: What Does it Cover and is it Worth it?

(Disclaimer: I only speak on my personal experiences as a private practice therapist dealing with insurance and private pay, and do not speak or represent the views or opinions of all private practices or therapists).

So the decision has been made to finally seek out a counselor! After researching for quality therapists in your area or gathering recommendations from friends or family, the next step is to determine what kind of bang for your buck you will get. I believe many of us these days tend to default to seeking providers who are covered within our insurance networks. After all, we've agreed to have our employers remove money from our paychecks to cover these plans for ourselves and/or our families, or we pay out of pocket for insurance on our own. However, does your insurance actually cover what you think for mental health counseling?

From my experience working with both insurance and private pay, this is what I've learned about clients and the insurance companies.

Many clients I've encountered who wanted to use their insurance did not understand how their plans worked. For those reading this article who might also be unfamiliar with insurance, I'll discuss the basics of insurance plans. For most private insurance plans, basic medical health needs and sometimes minor speciality services are covered on average between 50-90% before deductible. This means that most plans typically cover one or two general check ups at your primary care doctor per calendar year (some with or without a small co-pay) and/or one to two specialty physician visits per year with or without a co-pay (e.g. specialty physician being an endocrinologist). Anything after your one or two check ups will most of the time result in full price payment of whatever services are rendered. For example if you have a $4,000 deductible, your third or fourth trip to the doctor for the year may not equate to your $20 co-pay, but may end up being a few hundred dollars out of pocket.

Now, because insurance is predominately set up to cover medical expenses mental health is not always lumped in the same way. On average I saw about 15-25 people per 5 day week in 2016. This is roughly between 4,000-5,000 people per year in 2016. About 85-90% carried insurance and wanted to use their insurance for session coverage. Of that group, between 40-50% were covered by their insurance, such that they had an average co-pay of roughly $35. The remaining half or greater either paid for the entirety of session costs due to not meeting their deductible (individual and family deductible), or were responsible for a very large portion of the cost after insurance. An average cost of an individual counseling sessions can range from $75-$150 per session when seen by a licensed clinician. So if you need to come in once a week we're already talking $300-$600 in costs per month until the deductible is met, or indefinitely if mental health is excluded on your coverage!

So what are some things you can do to determine what is included and how your insurance covers mental health services?

First, understand your individual plan and what it covers. Call your insurance company and ask what they would be able to cover if you were to attend counseling. Second, be sure to ask how many sessions they will cover. Some insurance companies cover for an extended period of time while others only cover a certain number of sessions. Third, don't knock the out of pocket providers. Some therapists that do not accept insurance or that offer a separate cash fee may in fact provide a better deal than what your insurance company would be willing to reimburse.

So the take away? Do your research, gather your information, and from there make an informed decision. Don't be afraid to talk to potential therapists or private practices about these types of questions either. They are there to provide a service that you have every right to understand the ins and outs of how your mental health will factor monetarily into your life.

For more tips, articles, and information, please visit my Facebook page below!

Devin Pinkston is a local mental health counselor and Gender Therapist in Grand Junction Colorado. Call to schedule a free consultation today at 970-644-2392.

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