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Using your Insurance Benefit for Counseling
The Difference between an EAP and Insurance I have insurance. What do I do? Can I choose a therapist not on my provider panel? A CCD Therapist lists my insurance A CCD Therapist does not list my insurance What about Medicaid and Medicare? Well, that all seems rather confusing!
A "third party payor" is someone who is not the client and not the therapist, but a third party, and they are going to pay for the services that the client receives. There are two primary types of third party payors, and you may have both of them available to you. The first type is insurance and the second is an EAP, or Employee Assistance Program.
The Difference between an EAP and Insurance Your insurance is health insurance. It provides coverage for treatment of a medical problem. With regard to counseling, a medical problem is something that a professional diagnoses, based on specific diagnostic criteria, just like other medical illnesses or injuries. Common examples of mental health diagnoses include depression or anxiety. Like other health insurance, the available benefit varies widely with each plan. Your benefit may cover unlimited counseling with a $5 co-pay and no deductible, or your benefit may be 10 sessions a year with a $50 co-pay and a $ 5,000 deductible. An EAP (Employee Assistance Program) is a benefit that an employer provides for an employee. The EAP pays for an employee to receive services to assist them with a short term situational problem, which may or may not have a medical diagnosis. Some examples of problems that do not have a medical diagnosis would be couples counseling, or grieving a recent death. Even though these are not diagnosable conditions, the employer knows that they can interfere with the employee's ability to perform their job, so the employer would prefer that the employee be able to resolve them easily. EAP services are brief by definition. A common EAP benefit would be "up to six sessions per problem per year." Using the same examples, the employee and their spouse or partner may come and see a counselor about relational issues. After four sessions, they have accomplished their goals. Several months later, the employee's mother dies. The employee may attend counseling for "up to six sessions" to address issues related to their mother's death. EAP services are free for the client - there is no co-pay and no deductible.
I have insurance. What do I do? Most insurance companies require precertification for counseling services. On your insurance card you will find a toll free number. Sometimes it is the same number you call for other medical services, but more often there will be a separate number for mental health services. Call that number and tell them you would like to attend counseling. They will give you a precertification number and give you some names of therapists on their provider panel.
Most insurance companies now maintain a list of therapists that they have approved to provide services for the people they insure. CCD usually has at least one (and sometimes several) therapists on each insurance company's provider panel. If you open our therapist page before you call, you can easily cross-reference the two lists while you are on the phone.
If you have an EAP benefit, their toll-free number is usually posted prominently in your workplace. If you don't see it, call your Human Resource department. Once you have the number, call your EAP provider. A counselor who works for the EAP will discuss your needs with you. When appropriate, they will then refer you to a therapist in your community who is on their provider panel, and approve your first or first two sessions. Again, if you open our therapist page before you call, you can easily cross-reference the two lists while you are on the phone.
Can I choose a therapist not on my provider panel? That depends. Of course, if you are paying for your own services, you can always choose any therapist you like. When using an EAP benefit, you generally have to use someone on their provider panel. Some insurance companies have a different benefit for "out-of-network" providers. You can choose an "out of network" provider, but may have to pay a higher co-pay, for instance. Other companies permit you to see an "out of network" provider, but require you to file the claim, rather than the therapist filing for you. If you are unable to find an appropriate therapist within a reasonable distance who can see you in a reasonable amount of time, you should talk to your insurance company about your options. CCD also has sliding scale fees for eligible clients, which you should consider if faced with a high "out of network" co-pay, or an hour drive to an available "in network" therapist. You should also let your insurance company and/or HR department know if you are having trouble finding a therapist because that's one of the ways in which insurers realize they need to increase the size of their provider panel.
A CCD Therapist lists my insurance... Some therapists have chosen to list insurance companies that they regularly provide for. Unfortunately, this does not mean your services will be covered. Each insurance company has many different plans and while the therapist may be on the XYZ Insurance Everyone, International, Intergalactic, and Mercantile Plans, they may not be on the XYZ Insurance Everybody Plan. Your services also have to meet all the specifics of your coverage. The only way to know for sure is to call your insurance company and get a preauthorization number for that therapist.
A CCD Therapist does not list my insurance... Some therapist have chosen not to list insurance companies that they regularly provide for. That doesn't mean they don't want those clients. It usually means they are on many provider panels and many different plans and it would be too difficult to keep the list current. You also may be on an insurance that we rarely see and they have forgotten to list it. The only way to know for sure is to call your insurance company and get a preauthorization number for that therapist. Most of our fully licensed therapists are on some insurance panels. However if their license ends with the word "Intern," they are not on your insurance panel. Only fully licensed therapists are on insurance panels.
What about Medicaid and Medicare? Most of our fully licensed therapists (LPC, LCSW) are on Medicaid's provider panel. If they aren't, it's because they are still in the sometimes lengthy process of getting approved. None of our therapists accept Medicare.
Well, that all seems rather confusing! Welcome to our world! On a more reassuring note, most clients with insurance have no problem using their benefits. Just follow these simple steps: 1. Open our therapist page on your computer (or print it out), so you'll be ready to reference it. 2. Call the toll-free number on your insurance card (there may be a separate one for mental health services). 3. Tell whoever you speak to that you want counseling. There will be a number of questions about ID numbers and Plan numbers. 4. When they start offering you the names of approved providers, compare those names with our therapist list or ask specifically about a therapist you are interested in seeing. 5. Get a pre-certification number before you hang up. You should also confirm with them what your co-pay and deductible are under your plan. 6. Call or email the therapist you are pre-certified to see and request an appointment.
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