"I should use my insurance, right? I paid for it." Understanding Insurance and Why some choose NOT to use their benefits:
Insurance requires that treatment is MEDICALLY necessary. Not all reasons for counseling meet medical necessity. Some people just feel mentally stuck. They want to improve some aspect of their life or improve career or sports performance. These and many more don't meet medical necessity.
Insurance companies control & may restrict the number or length of sessions you can have. Some companies only allow 45 minute sessions. Some only cover a specific number of sessions. Some require referrals so you have to see your primary care provider first.
Insurance requires a diagnosis and it becomes a permanent part of your health records. To use insurance, you must waive your confidentiality. To determine payment, they require a diagnosis and may request your treatment plan and session notes. They can request copies of all documents in your file in an audit so you have no control over the information.
Insurance Companies set the fee you are obligated to pay and the provider is contracted to accept. Before they will pay for any of your sessions, most people have to meet an annual deductible. This can be as much as $6000 in addition to the premiums! Many people fortunately don't have enough health issues meet the annual deductible. However, this means all treatments are out of pocket anyway. The insurance company determines the fee you pay and this fee is frequently at a HIGHER COST than if you chose to self pay.
Employee Assistance Programs (EAP) Many people are unaware of this benefit that is provided by many area employers. EAP programs frequently include 3-10 sessions at no cost to you. They do not require medical necessity and are completely confidential. Contact your HR person for more information. In-Network Insurance Companies Aetna Ambetter American Behavioral Arkansas Blue Cross Blue Shield Arkansas Managed Care Organization CIGNA Behavioral Health Compsych EGID HealthAdvocate Healthscope Magellan Health Services MEDICARE - provided in our office by colleague, Brandy Cunningham, LCSW only. Meritain MHNET Municipal Health Benefit Fund Optum Health Behavioral Solutions OSEEGIB QualChoice Tricare East UnitedHealthcare UMR and many others