Health Insurance Coverage - Psychotherapy

A major part of the cost of psychological treatment is related to the personal attention and individual treatment you receive from a psychologist. For example, when you visit your family physician for a problem, you might receive between five and fifteen minutes of one-on-one attention from your physician during an office visit. However, psychotherapy appointments are 45 – 60 minutes. For testing and evaluation services, a psychologist may spend several hours with you. The fees charged for psychological services reflect this time and personal attention. Actually, the cost of psychological services is far lower than other medical services.

Some people delay starting psychotherapy because they are not sure if the cost of psychological treatment is covered by their health insurance, and/or because they believe they cannot afford treatment. Health plan brochures are often misleading or vague, leading to doubts about coverage. Managed care can add to the confusion because the same plan may provide different coverage, and have different co-pays and deductibles, depending on the contract negotiated with your employer.

Types of Health Insurance Coverage

Health insurance can be provided as an HMO, a PPO (preferred Provider Option), or traditional Point of Service plans. Some HMO plans do not cover the cost f any treatment provided outside of your network. PPO plans typically have an Out of Network option. If you see an in-network provider, you pay a set copay, and if you see a psychologist Out of Network, you pay a set deductible, and then the plan will reimburse you a percentage of the costs beyond the deductible. The percentage varies from plan to plan.

Your insurance company will want you to stay within their network. This reduces their cost, and also allows them to manage your treatment. They will require regular updates from your treatment provider, and will approve specific numbers of treatment sessions. Often, the person actually making the decisions about your treatment is not a licensed psychologist, and may not even have graduate training. They are essentially clerks with a handbook that determines what services will be approved.

Out of Network Benefits

If you choose to use your Out of Network benefits, the insurance company cannot gain access to your confidential treatment information, other than what is required to process your insurance claim. This generally includes diagnosis, dates of service, and service codes. The specifics of your treatment remain confidential. The only limitation imposed by your insurance company is your deductible, and the percentage of the cost to be reimbursed. You may also have an annual maximum amount of coverage. However, the Affordable Care Act (often called Obamacare) prohibits health plans from putting a lifetime dollar limit on most benefits you receive. The law also restricts and phases out the annual dollar limits a health plan can place on most of your benefits — and does away with these limits entirely in 2014.

Dr. Franklin does not participate in any managed care plans. However, you can use your Out of Network benefits to cover part of the cost of psychological treatment. Dr. Franklin will provide you with the statements required for you to receive reimbursement from your insurance plan. In addition, you can use a credit card to pay for your out of pocket expenses, if you wish to do so. This can help you to spread the cost of treatment over a longer period of time.

How many treatment sessions will be needed (approximately)?

Generally, adjustment problems can be addressed in six to twelve sessions, moderate problems in ten to twenty-five sessions, and more serious problems require twenty or more sessions. The number of sessions required for your problem will depend on the specifics of the issue.

How often will treatment sessions be scheduled?

Typically, treatment sessions are scheduled once per week, at least until there is progress in treatment. If a person is experiencing a crisis, sessions may be scheduled more than once per week.  Once treatment is progressing, you may opt to have sessions less than once per week. The appropriateness of scheduling sessions less than once per week is a clinical decision, depending on issues in the case.

What is the cost of not receiving treatment?

Postoponing psychological treatment can have a negative effect on your personal health, your work, and your family. When you are struggling with emotional problems, it can affect many areas of your life. At work, your productivity can suffer, especially in areas that require concentration and decision making.  Stress appears to depress the functioning of your immune system, so you are at greater risk for physical illness. In fact, one study found that people who had easier access to mental health services, before the problems become crises, tended to spend about half as many days hospitalized for physical health problems, as compared to those who don't use mental health services when needed. And of course, emotional problems place a great stress on your family, and increase family relationship conflicts. If you consider all these factors, seeking psychological treatment when needed appears to be the best preventative health care you can get.