[GBanner]

I am currently seeing an out-of-network provider for weekly sessions (and have been doing so for a number of years). My insurance, United HealthCare, sent me a determination several years ago that they would only cover (at 70% reimbursement) once-weekly sessions (perhaps due to my diagnostic code, which is not dire). However, I am approaching a number of very stressful life events occurring at the same time - beginning grad school while working full-time, two kids at home, and several others - and would love the option to see my therapist twice weekly. However, I simply cannot afford to pay my therapist's full fee for a second session.

Does anyone know of any way of persuading insurance to expand their determination to cover sessions twice weekly, if only for a limited period of time? Or can my provider do something to recode my diagnosis that would help persuade them to do so?

Also, my wife and I saw a couples therapist for a few months not long ago, who happened to be in-network, and my insurance covered his fee (less a small co-pay), even though he submitted the claims under my name and probably used a mental health diagnostic code (although I can't be sure). So I was essentially seeing two different therapists a week at the time, and being covered for both. Why would they cover two sessions a week for different providers but not two sessions a week for the same provider?

[Skeezyks]

Hello GBanner: I see this is your first post here on PC. So... welcome to PsychCentral… from the Skeezyks! I hope you find the time you spend here to be of benefit.

Insurance regulations vary from state to state & from insurer to insurer. So, from my perspective, there's probably not much I can offer with regard to your concerns, given that I'm not in New York State. From my experience, it is pretty typical for health insurers to set restrictions related to the use of out-of-network providers. I always try to make sure that any provider I see is in-network. So your options may be to find an in-network provider or possibly appeal the insurer's decision. I presume there is some appeals process. Most insurers seem to have one. (Where I live it is state law that mental health patients have the right to see the provider of their choice.)

PsychCentral is a great place to get information as well as support for mental health issues. There are many knowledgeable & caring members here. The more you post, & reply to other members’ posts, the more a part of the community you will become. Plus there are social groups you can join & chat rooms where you’ll be able to connect with other PC members in real time (once your first 5 posts have been reviewed & approved.) Lots of great stuff! So please keep posting!

P.S. If there is a disability law center or health insurance advocacy center of some sort where you live, you might consider running your situation by them.

[BeyondtheRainbow]

I got 2 visits covered per week for a while (I think 3 months or so) when I had just gotten out of the hospital and was under a lot of stress at work. However my insurance then suddenly turned on me and required my therapist send in a ton of paperwork proving I needed treatment. Based on that they said that I had an incurable disorder (bipolar I) and could not benefit from treatment due to a lack of insight (my therapist absolutely did not agree with this and he had been treating me for 4 years at the time so knew me well) and so they were reducing it to once a month. We fought and got twice a month and my therapist's office gave me a reduced rate for the other 2 visits (I was ready to go to weekly by the end of that battle).

I know when there is marriage/family therapy one person has to be the patient and that is submitted with a diagnostic code. I don't know how they determine that the 2 kinds of treatment are beneficial to the one person, but I do know it is billed that way. Perhaps they billed it as your spouse having issues coping with your disorder? I have no idea.