Using Your Insurance Benefit for Counseling
- Types of Third Party Payors
- The Difference between an EAP and Insurance
- I have insurance. What do I do?
- What is a provider panel?
- Using EAP benefits
- 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.
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
Most insurance companies require pre-certification 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 pre-certification 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. Warning: Sometimes,
instead of listing individual therapists, we are listed as a group. So if you ask if
Cindy Jacobson is an approved provider, they will tell you, “no,” but if you ask if
CCD Counseling PA is approved, they will say “yes!” Of course we are happy that
we are all approved but know it can be confusing if clients don’t know to ask about the agency name.
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.
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.
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.
Some therapists 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.
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.
Welcome to our world! On a more reassuring note, most clients with insurance
have no problem using their benefits. Just follow these simple steps:
- Open our therapist page on your computer (or print it out), so you’ll be ready to reference it.
- Call the toll-free number on your insurance card (there may be a separate
one for mental health services).
- Tell whoever you speak to that you want counseling. There will be a number
of questions about ID numbers and Plan numbers.
- 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.
- 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.
- Call or email the therapist you are pre-certified to see and request an appointment.