Your Insurance Options

Do you take insurance?

I am considered an out-of-network provider and I do NOT bill insurance.

However, if you have a PPO, I can provide you with a superbill, which is essentially an invoice showing the amount of money you’ve paid for therapy. You can then submit the superbill to your insurance company for the amount to either go towards your deductible or to be reimbursed a percentage of the cost. This depends on your insurance plan and the insurance company.

Fortunately, there are currently some third-party companies that can advocate for you with your insurance company so you can get reimbursed. The Superbill is one company that is an affordable option for this, if you both feel it is needed and you feel comfortable including another third-party in your care.

Please note that all superbills require a mental health diagnosis.

For more information on your coverage, contact your health insurance provider.

What are my options in using insurance for therapy? Do I want to use insurance for therapy?

Figuring out the maze of insurance when it comes to getting access to psychotherapy can be messy and stressful. Here’s an outline of all the options that are available to you so you can determine which avenue is the best fit for you:

(1) Do you have an HMO or PPO?

HMO: Insurance will only cover in-network therapists (this generally includes people who have coverage through Medi-Cal or Medicare)

• Pros:
  • Low cost for you
  • Finding a therapist is fairly straightforward. For this option, you will contact your insurance company and find out which therapists are in-network. You then contact the therapist, schedule and you’re good to go!
  • * For those with Kaiser, patients used to receive a referral for Magellan or Beacon and then find a therapist in those networks. As of 2020, Kaiser is now directly paneled with therapists, so the process should be easier. However, as of late 2021, I have heard that Kaiser is generally pushing people into in-house, short-term group therapy. So in order to get a referral, you have to be very assertive in stating that you do not want group therapy and that you want a therapist you can see every week. If they ask why, you can tell them you’ve tried it in the past and know it doesn’t work for you. You also need to really emphasize to them your current mental health status and how much you need therapy in order to get a referral with a therapist who is in contract with Kaiser.
• Cons:
  • You may not get to choose your therapist.
  • There’s a higher likelihood that the therapists paneled with insurance companies are full (even if the insurance’s website states they’re taking new clients), so there are limited options and you may be placed on a long waitlist.
  • With some insurance companies, you might discover that the therapists they list as in-network are no longer accepting clients for various reasons. For example, they have retired or they have passed away. This is often referred to as “ghost networks”, which you can read more about here.
  • Your insurance company dictates the treatment. Your insurance company has say over which issues, which approaches, and which therapists they will pay for and for how long. For example, with some insurance companies, you might be cut off after a certain number of sessions.
  • To receive coverage for therapy, you’ll be required to have a mental health diagnosis, which will go on your medical health record.

PPO: Out-of-Network Options

• Pros:
  • You have more choice over what kind of therapist you want to work with. You can find someone specialized in your issues or who has an approach that wouldn’t be covered if in-network.
  • More options for session times.
  • Easier to change therapists if either you or the therapist determine it isn’t the right fit.
• Cons:
  • A mental health diagnosis is required on your superbill.
  • You will need to pay for sessions out of pocket initially and then submit the superbill to get reimbursed or have it go towards your deductible, depending on your plan.
  • It may take a while for the health insurance company to reimburse you, IF they decide to reimburse you.
  • Your insurance company may decide to delay or reject your request for reimbursement for any reason. **However, there are companies out there who can now advocate for you with your insurance company to ensure that you do get reimbursed. One of those companies is The Superbill, who you can pay as little as $5/month to submit your superbills for you and do the busy work.

(2) Do you have an HSA or FSA card?

HSA and FSA cards are like debit cards that you can only use for medical expenses. Depending on your plan, therapy may be eligible. The benefit of using an HSA or FSA is that the accounts are pre-tax, so you save money over time. Here are the differences between the two:

• HSA (Health Savings Account) – It can be more difficult to apply for. However, it is not tied to your employment so you can take it wherever you go.
• FSA (Flexible Spending Account) – It is a “use it or lose it” system that is tied to your employment, but it is easier to apply for.

(3) Paying Out of Pocket (Private Pay)

Pros

• You can work with any therapist of your choosing.

• You can choose a therapist who is specialized in the issues you want support with.

• You can choose a therapist who uses modalities that are relatively new, alternative, or simply not covered by insurance (like Brainspotting).

• You don’t have a third party (ie, your insurance company) who is dictating your treatment in any way, which makes it easier to collaborate with your therapist.

• No mental health diagnosis on your medical record, because no insurance company receives information about your therapy.

• Depending on your tax situation, you may be able to write off the money you spent on therapy as a medical expense at the end of the year.

• You’re the boss of your own treatment!

Cons

• It’s usually more expensive.