Insurance Questions?

I'm looking at a new insurance plan which says, "mental health outpatient - no limit on visits". Does that really mean what it says? Is "mental health outpatient" regular therapy sessions?

Does it matter that I've been going 3x a week for the past year - will they still pay out? It's not like it's a typical once a week or once every two weeks type of situation.

I want to figure out if they will really be covered before I sign up for it. If not then I'm paying out of pocket for therapy still and an insurance plan I won't use.

Thoughts? All of this insurance stuff confuses the crap out of me.

I would call and ask to be sure, but it does sound like they would cover all your outpatient sessions probably there is a co-pay, though.

Gayleggs point about copay is excellent.

You might want to make sure that your T is a participating provider. In network. Can't think of the right words right now. Sorry.

Yes there is a copay and paying the copay is cheaper than the full session price

The insurance I have does seem to pay for as many sessions as I want. There is a copay and that can get expensive at times but it is definitely better then paying out of pocket. However, if you can you should just call the company and see if they can clarify. It's better to be sure before signing up.

Ask the right questions before you switch. it would seem outpatient sessions is covered. ensure inpatient is also covered. ask about yearly limits on both. ask if you have to choose from their therapists, ask for a listing and review it. contact therapistsvand inquire as to their methods and success. if you want to keep current therapist check with him or her to see if the accept this insurance. if no, ask them to enroll with the insurance so you can keep them. good luck

"no limits" doesn't exactly mean "no limits".... I mean there are programs out there that are literally ALL DAY individual therapy on an outpatient basis, and no insurance company will cover the program. (Think.....6+ individual sessions a day.) You need to contact the company to determine exactly what this means.

You should be able to find the answers online on the site they have? Remember that a session is usually computed at a 50 minute hour... so even if the therapist sees you for a 2 hour session, and bills for that, they will only cover it as a one session 50 minute hour.

If you are in the USA, then coexisting issues are covered. And yes, like monkey said, check and see what limits there are... there are always disclosures imo...is there an asterisk? lol There might be a program baseline they work from on each topic... but it does sound like you've hit gold there... and yes, they probably do require a network doctor for the top payment..

good wishes

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check the web site or call the company for the small print. There is almost always limits or exclusions that apply. I would get as many details as possible before making a decision.

Hi Ellahmae... did you get it figured out? Did you end up purchasing that insurance?

My insurance (through work, so I don't have another option) also says "no limits" on outpatient mental health. But, when I called them to double check, they said "no limits as long as it's medically necessary."

It sounded like they might disagree with me on medically necessary, and reserve the right to stop paying for therapy. For example, my (out of network) T has me diagnosed as "dysthmia" - i.e. mild depression. He wanted to choose something that would be likely to have the least possible negative effect for me in the future (sometimes having something officially diagnosed in your insurance can affect you later on, for example, if you want to buy life insurance, I think?)

It's possible that at some point they'd say, "well, for dysthmia, that really should be cured with XX sessions... so we won't cover any more."

They haven't yet. But, again, my T is out of network, so they don't cover much of it anyway...

Good luck, hope you got what you needed!

All insurance covers necessary treatment only, and they are happy to define that and decide what constitutes necessary . Most therapists know the game of insurance, and how to get their patients the services they need. So, see what your therapist has to say too.

My insurance covers therapy at 100%, no copay, no limits. But I have an 8 year relationship with my therapist, who is not a member of the insurance plan's provider network. She reduced her fee dramatically for me so insurance is not even involved, and I like it that way

Insurance is "insurance" and is an "in case" you get sick thing. No insurance is going to continue to pay out more than you pay in for very long, there is no way that can work. Insurance generally gets a better rate for doctors instead of the "real" rate, and/or there's high deductibles (mine was $4000) to keep the monthly premiums lower, etc. If you see a therapist 3x a week, you are still going to be paying a lot out-of-pocket, just maybe not as much as you would be without insurance but don't forget to take your monthly premiums in consideration of the costs; it is possible to be paying more for insurance than you are getting from it, if you forget the monthly premiums count too.

With something like mental health, eye, dental and individual illness-types of insurance, the premiums are going to be larger or what is covered, less, because not everyone uses that kind of insurance so there is not a very big pool of people not using it but paying premiums "in case" to cover those who use it more. Because of that, insurance without mental health coverage will be less expensive than that with mental health coverage. Check, too, that your therapist takes that kind of insurance!