Paying For My Care

Learn how your insurance works and other payment methods to better understand how to access mental healthcare.

Insurance FAQ

What are the first steps to pay with insurance?

Confused about how to pay for mental healthcare with your insurance? First, learn more about your coverage by following these steps:
  1. Find your insurance card
  2. Call your insurance company. The phone number is likely on the back of your card and may be listed under "behavioral health service" or "customer call". You can also go to our Insurance Company Directory to find your insurance company number. Keep in mind that some insurance companies are open 24/7 and others are only available during workday hours.
  3. Get information about your benefits
    1. After dialing the behavioral health services or customer call phone number, you will be connected to an operator and eventually to a representative from your insurance company. They will ask you to verify some of your information to ensure that you’re covered by the insurance plan. When they ask why you called, you could say, “I want to find out what benefits I have to cover for mental health services."
    2. To learn how much your plan requires you to pay for each time you go to a provider, ask how much you would pay per session. This payment is called a ‘copay’ or ‘coinsurance’. Some insurance plans have an amount that you have to pay out-of-pocket first; this is called a ‘deductible.’ Once you pay that amount your insurance company will cover part or all of your visit depending on your coverage.
    3. Insurance plans tend to vary, so it is important to look over the questions to keep in mind when learning about your insurance benefits.

What does it mean for a healthcare provider to be out-of-network?

Healthcare providers who are out-of-network are usually not covered by your health insurance policy. You will usually have to pay oout-of-pocket for out-of-network providers. This payment is much higher than it would be if you had gone to an in-network provider. However, if your insurance company is a PPO or a POS, depending on their policy, the insurance would pay for some of the costs of an out-of-network providers.

If I have insurance, how much will my appointments cost?

While appointments at your campus counseling center can be covered completely, once they refer you to a provider outside of the campus center, those appointments will be covered by your insurance or you will have to pay out-of-pocket. The cost depends on the type of insurance plan you have and if your doctor is in-network or out-of-network. Usually, all you have to pay when you’re going to a provider covered by your insurance company is a set amount of money called a copay (around $15-35). This amount is usually printed on the back of your insurance card. Typically, you end up paying more when going to doctors that are not covered by your company (out-of-network). For more information, contact your insurance company and ask them about their rates for doctors that are in-network and out-of-network.

What if my insurance does not have any in-network providers in my area?

If your insurance does not have any in-network providers in your area you will have to go to an out-of-network provider.

What is the difference between a Copay and Coinsurance?

Copays are flat-fees that you pay during a visit to a health provider or for prescription medications. Coinsurances are similar to copays, but instead of a flat-fee, you pay a percentage of the cost of service or prescription. For example, a 20% coinsurance for a $200 bill means you would pay $40.

Each insurance plan will have an out-of-pocket maximum and that number will be the absolute maximum you will have to contribute annually and this includes copays and coinsurance fees along with deductibles. Any other costs associated with your healthcare is expected to be covered by your insurance company.

What are some of the advantages I have when I use insurance?

Insurance greatly reduces the amount of money you pay upfront for your doctor’s visits or medications. Insurance plans will cover your healthcare from providers within their network and some cover out-of-network. Doctors in your insurance company’s network can give you services for little to no out-of-pocket costs. Insurance will also cover all or some of the medications that you need to get from the pharmacy if your insurance has prescription benefits. For example, a $300 prescription could cost you only $10 out-of-pocket.

Insurance also greatly reduces the amount of money you pay for emergency care. Medical emergencies are extremely costly, even if it is just the cost of checking into the hospital for only one night. This costs rises if you need extra services, like having a surgery or staying at a rehabilitation center.

Are there any disadvantages to using insurance?

The disadvantages of using insurance depend on the type of insurance plan that you have. Unfortunately, your insurance won’t cover the cost of a visit with just any doctor. The most common disadvantage of using insurance is this network limitation where most insurance companies–but not all–limit your coverage to in-network providers. Moreover, some insurance companies require you to get a referral from your primary care physician before you can go to specialists. Insurance companies may even limit the kind of mental health treatment you can receive. To learn more about what your insurance company covers, you can either visit their website, call to talk to a representative.

If I have a mental illness diagnosis can my insurance classify this as a preexisting condition and change my benefits?

You cannot be charged more or refused coverage because you have a preexisting condition. Once you have insurance, the company cannot refuse to cover treatment on the basis of it being a preexisting condition.

Will my parents know I'm going to a mental health provider if I am on their insurance plan?

Mental health providers are required, by law, to keep your information confidential. However, if you are on your parents insurance plan or if they receive your medical bills and statements, they might see some information (like the type of service and date) from the bill. Changing the address for the bills and statements or, if on their insurance, paying out-of-pocket for the full cost of the mental health service would ensure this information is kept private from your parents.

Is there anything I can do to get my medication covered, if my insurance plan refused to cover it?

You can file for a drug exemption request. Generally the process requires your doctor to write an explanation as to why the drug is appropriate for your medical condition. You must wait for the exception to be approved or denied. However, it is important to check with your insurance on their process for requesting for a drug exemption because this varies by plan.

Can I go to a mental health provider without clarifying with my insurance company that they will cover the cost?

Not all health insurance companies require pre-certification or a referral before seeing a mental health provider. However, there are many plans that do require you to have precertification or a referral from your PCP. Thus, it is important to check what benefits your insurance covers beforehand.

If I pay out of pocket, how do I get my insurance to reimburse this cost?

  1. First, make sure your insurance covers these services.
    You want to make sure that the services that you are interested in getting reimbursed are within your benefits by checking your EOB. Furthermore, consider if these services are in-network or out-of-network. Some insurances will only cover in-network services, so it is important to check if your insurance also covers services from out-of-network providers. You can find this information on your insurance’s website or by calling and talking to a representative.
  2. Second, follow these steps to get reimbursed by your insurance.
    In some cases your provider can fill out the form to get their services reimbursed. If your provider does not fill out the reimbursement form, you will have to do this. Here are the steps to file this claim:
    1. Request receipts.
      If they are within your benefits, you will need to request itemized receipts from your provider to add to your claim.
    2. Download claim.
      To get this claim you can download it from your insurance's website. (This form will have further instructions regarding the logistical information needed to add to the claim).
    3. Cover your bases.
      Claims may get rejected, so it is important that the information is correct. Moreover, if a claim was lost or had slight mistakes, it is handy to have a copy just in case.

How do I get precertification for a service?

In most cases, your provider or hospital will request precertifications. In the event that you have to request it, you can request this online, via Fax, or by talking to a representative. Requests are prioritized based on medical necessity. Healthcare procedures, medications or services on the precertification list of your insurance plan can require you to notify or get a coverage determination. In the case of notification, you just have to file a form to record the healthcare service or procedure you will be receiving, but the insurance company does not have to make a decision on whether to accept to cover you. In the case of precertification for coverage determination, the insurance company will look at plan documents and clinical information to determine whether to cover that healthcare service, medication or procedure. In the case of emergency services that are on the precertification list, prior authorization is typically not required and instead you have to notify within 24 hours or the next business day.

For example, your insurance will have a list of medications that are covered, but some are not on this list and require precertification. If you go to your pharmacy, your pharmacist will contact your insurance to get precertification. Your insurance will then request a precertification from your doctor. Your doctor will express the medical necessity of your medication, and then your insurance will decide based on a medical necessity criteria whether your insurance can cover the medication. Your pharmacy will then alert you whether you medication was approved or not.

Do I have to notify my insurance company when I move to a different address or state?

Depending on where you move, your insurance policy may change. If you move to a different state, it is very important that you notify your insurance company because you may need to switch to a new plan or a different company. You can follow these steps to update your address online. You can also call your insurance and talk to a representative. If you move within your state, your plan won’t change, it is only important for you to update your address in case you ever receive mail from your insurance. However, the exception is for some HMO plans that provide service coverage for specific counties, so an address change can mean you go to a different facility and network of providers.

How do I know if my insurance covers mental healthcare?

To learn more about your insurance company’s policies, you can look at the website or call to talk to a representative.

It’s important to know that some insurance companies outsource part of their mental health coverage to other companies. Again, you can look at the website or call to talk to a representative to find out if your insurance company outsources your mental health coverage.

Will insurance cover all of my medications’ cost completely?

The amount you pay for medications is based on your insurance. Some medications have a copay, some are completely covered and some are not covered at all. There are several categories of medication: preferred, non-preferred, generic and name-brand. Each insurance plan has a Prescription Drug List (PDL) which are preferred medications. Preferred medications have the best overall value, which is determined by your insurance and based on its effectiveness and safety. Within the PDL there are “generic” and “name-brand” medications. Generic medications are copies of name-brands that work the same and have the same active ingredient, but have a lower copay. A name-brand medication tends to be prescribed if the generic equivalent is not available. This depends on the pharmacy and the drug. Medications are organized in tiers based on the amount you pay. The first tier having the lowest copay, and the last tier having the highest copay. The first tier is preferred generic, the second tier is non-preferred generic, the third tier is preferred name-brand and the fourth tier is non-preferred name-brand.

Paying Out-of-Pocket FAQ

What are some advantages of paying out-of-pocket?

An important consideration is the flexibility of paying out-of-pocket. You are not constrained to meet certain requirements (such as a referral from your primary care provider or condition/treatment coverage limits) to obtain care or having to fill out paperwork to get prior approval for care. You also have more freedom to choose duration, focus, frequency and treatment modality best suited to your needs.

Are there any disadvantages of paying out-of-pocket?

Given that the biggest obstacle is immediate expense, some mental health providers or centers offer reduced rates based on income or family size. To learn more about this, check out our Payment Assistance section. Mental Health Providers are free to set their own rates and offer a sliding scale when paying out-of-pocket. This can lead to paying even less than with insurance depending on where you fit in the sliding scale, duration of treatment, and details of insurance plan. It is helpful that when you first see your therapist, you communicate what you can afford while also showing a willingness to be flexible. This could mean that you might have to compromise on some things (such as having your appointments at off-peak hours early in the morning) to get the services you need. Many therapists would be willing to work with you based on your ability to pay so make sure you ask about sliding scale fees.

Does it matter what I use to pay for my services?

The method of payment you use to pay for your services depend on where you go for your mental healthcare. Most providers take debit/credit cards, cash, or check. Some mental health providers will allow you to use other modes of payment such as PayPal. You can also take out a loan in order to pay for your medical bills.

Paying Assistance FAQ

What is Payment Assistance?

If you need help paying for your mental healthcare, you can receive assistance to pay for your medical bills or render services for little to no cost. Various government and non-profit programs provide payment assistance that help pay for individual's healthcare. Some types include: ATR Voucher, charity care programs, federal, or any government funding for substance abuse programs, grants from nonprofit and government agencies, IHS/Tribal/Urban (ITU) funds, local assistance programs, state welfare or child and family services funds, and U.S Department of VA funds. There are also some cases where no payment is needed.

Who can receive payment assistance?

Qualification for payment assistance are often based on income and need according to the Federal Poverty Guideline. Payment assistance is for people who do not have insurance or who have insurance that does not cover their mental healthcare needs.

What does it mean if a provider offers a sliding scale?

A provider that has a sliding scale offers a flexible fee system that varies with income. This means that the lower your income, the lower the fee you have to pay for your session. The amount you pay should not be reflected on the quality of care you receive and the time you have with the provider. Most times providers don’t even know how much you pay because their office personnel handle it separately.

In which cases is no payment needed?

Services for which no payment is needed are typically available from non-profits or charitable organizations that have therapists, psychologists, or psychiatrists who donate their time and see patients for no cost. Many colleges or universities offer services to students through a Counseling Center or Health Center that are covered by the fees they have already paid to the university. Additionally, there are free mental health apps that can serve as tools for therapy.
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