Got Insurance Woes?

Got insurance woes? The December 2016 issue of Money (money.com) magazine has a great article titled The High Cost of Coping.  This article confirms what many of you have said for years now: insurance companies treat mental health claims differently than physical health claims, it seems impossible to find a provider who is in network, and depression and anxiety prevent people from filing insurance paperwork.

Problems with Claims

Money notes that prior authorizations are required more often for mental health than physical health claims, patients with mental health concerns are required to “fail” at lesser treatments before more intensive treatment is covered, and utilization reviews are more common with mental health claims than physical health claims.

Money recommends that you file appeals, clearly identify the treatment you want, use phrases found in your benefits plan, bring an advocate, and escalate your complaint.  (Sounds totally reasonable if you are That Parent, and basically impossible if you struggle even the slightest bit with anxiety, depression, organization, or a busy schedule).

Find an in-network provider

You’ve said it before, and Money says it again: psychiatrists and other mental health professionals just don’t seem to be on insurance panels! Docs cite low reimbursement rates, paperwork demands, and bureaucracy as reasons to avoid taking insurance.  (Yeah, that sounds about right.  Sorry!)

Proposed solutions? Ask for physician for recommendations for local providers, check out-of-network options, negotiate fees with the provider, and try the website FairHealthConsumer.org to see what local docs charge (use code 90834 as the billable code for therapy).  (Not mentioned in the article: call your insurer and require them to provide you with the contact info of a doc who can see you within two weeks.  Some states require insurance to actually Do Their Jobs and this is often one of the requirements!)

Insurance is tricky business.  Most of us want to use our benefits, yet mental health providers often choose not to participate in insurance contracts.  I sit on both sides of that equation: I want to use my benefits, and as a provider, I choose not to participate.

Perhaps the Money article will provide new information or ideas for you.  The article is comprehensive, thoughtful, and helpful.  I was not able to find the article online for a link, so perhaps track down the actual magazine for your reading pleasure.  (If you can find the link, PLEASE send it to me and I’ll fix this post asap!)