[Elio]

I have been talking with my T about increasing sessions from 2 x week to 3 or 4. One of the things that has come up is insurance coverage. Anyone here go 3-4 x week and if so, does your insurance cover it? Did you have to do anything extra to get it covered? Was it much of a fight?

My insurance is unlimited for medically necessity treatment.

Feel free to PM me responses.

[UnderRugSwept]

Hi Elio,

I see one T 3 times a week and another once a week. The appts are processed just like dr's (medical) visits, so they have been covered without issue for the past few years. (This year things have changed a bit with my insurance, so still waiting to see how the claims are processed, which I am nervous about).
Several years ago I tried seeing a T 2x a week, and my insurance at that time refused to cover the second appt (unless I was suicidal, and that would only be for short-term).
It sounds like your insurance has been fine with 2x a week though, no issues? My guess is that if they are ok with 2 a week (unless your T has to get pre-approval for them), then 3-4 probably wouldn't be an issue?

[NP_Complete]

I've been going 3x week for a while now. They paid for a while, but finally sent a letter to my therapist (PsyD, not psychiatrist) saying that either I needed a higher level of care or they would only pay for once a week. So now, they only pay for one session a week. They also covered group therapy though.

[waterlogged]

My situation is like UnderRug - I go 5x/week and they are covered like medical visits. Once I meet our deductible, they cover 70%, and once we meet our family out of pocket max, they are covered at 100%. I don’t think they’d cover 2 appointments in one day.

[fille_folle]

My understanding is that here in the US, where I live, it's unusual for insurance to be ok with more than twice per week. They usually demand a higher level of care, like PHP or IOP, if you need that many sessions

[feralkittymom]

If there is a limit on # of sessions per week, it will be specified in your plan. They cannot be ambiguous about it, nor change the terms within the coverage period. If the plan is ACA compatible, psych is treated the same as a medical benefit.

I only go 1x a week, but the only limitation on my plan, which is the biggest in my state, is no more than one session per day outpatient.

I've been paying out of pocket for a long time now. However, since with h's recent 6 day hospital stay we'll almost certainly meet our family deductible after paying all the bills, I'll be able to submit receipts to my insurance and get paid back 50% (she's out of network, otherwise it would be more.) I'm researching it now actually to figure out if there's a limit to the number of sessions. I already know they won't cover over 50 minute sessions, so we're going to have to adjust there.

[LonesomeTonight]

Originally Posted by ArtieSwimsOn

I've been paying out of pocket for a long time now. However, since with h's recent 6 day hospital stay we'll almost certainly meet our family deductible after paying all the bills, I'll be able to submit receipts to my insurance and get paid back 50% (she's out of network, otherwise it would be more.) I'm researching it now actually to figure out if there's a limit to the number of sessions. I already know they won't cover over 50 minute sessions, so we're going to have to adjust there.

Could your T just bill for 50 minutes but keep you longer? My T codes it as 45 minutes but generally keeps me for an hour.

[MoxieDoxie]

I hope I do not have issues. I see on T for talk therapy and just started with another T for EMDR.

Originally Posted by LonesomeTonight

Could your T just bill for 50 minutes but keep you longer? My T codes it as 45 minutes but generally keeps me for an hour.

She probably will.

[MoxieDoxie]

Originally Posted by ArtieSwimsOn

She probably will.

I do not know why my T bills for 45 mins and then keeps me an hour or longer. He is getting less pay. The nutritionist I see gets more money from the insurance company then my T does. That just does not seem right. I see he charges the insurance $120 a session, I pay $30 and the insurance pays him $50. Geez that is only $80 to put up with people's crap. The nutritionist charges $160 an session, I pay nothing and the insurance gives her $85.

[Elio]

I believe my T bills for the 45 mins and we regularly go for almost the full 60.. and some over that. Though I've been better lately at staying closer to the 60.

I am not the only one that she goes the close to the hour mark.

I did find some stuff on the insurance website and I talked to someone in behavioral health. It's scary because if I increase frequency and they pull for an audit they might decide that they won't even pay for the 2x a week I currently get. Though I think my T could get that covered. Not sure though. My T is a pDoc so not sure if that would make it easier/better to get more coverage or not.

She did say that if I paid out of pocket it would be less than she bills the insurance; which is pretty common.

[LonesomeTonight]

Originally Posted by MoxieDoxie

I do not know why my T bills for 45 mins and then keeps me an hour or longer. He is getting less pay. The nutritionist I see gets more money from the insurance company then my T does. That just does not seem right. I see he charges the insurance $120 a session, I pay $30 and the insurance pays him $50. Geez that is only $80 to put up with people's crap. The nutritionist charges $160 an session, I pay nothing and the insurance gives her $85.

I figure it's up to a T how they want to run their practice. My guess is your T brings in enough money doing it that way. Honestly, $80 an hour is a pretty good pay rate...certainly more than I make!

With my T (as well as marriage counselor and ex-T), he's out of network, so I pay him his full fee ($175--T's are quite pricey in my area), then submit to insurance for partial (60%) reimbursement. So he gets the full amount, and insurance pays me part back. Though my T also rents (or maybe owns?) his office space, so has to pay rent/mortgage on that, plus I imagine other expenses (electricity, malpractice insurance, cleaning service maybe?), so he's not actually taking all of that home. Well, plus taxes...

[kecanoe]

My insurance has paid for up to 6 sessions/week. They have also paid for me to see more than one provider in a single day. They will not pay for two sessions with the same provider/same day. I am in the US and have Blue Cross.

[Wonderfalls]

Originally Posted by kecanoe

My insurance has paid for up to 6 sessions/week. They have also paid for me to see more than one provider in a single day. They will not pay for two sessions with the same provider/same day. I am in the US and have Blue Cross.

Wow! Just, wow!

[wheeler]

I’m in the US and I see my T 3x a week. Other than the $10 deductible my insurance covers the visits.

[LonesomeTonight]

Originally Posted by kecanoe

My insurance has paid for up to 6 sessions/week. They have also paid for me to see more than one provider in a single day. They will not pay for two sessions with the same provider/same day. I am in the US and have Blue Cross.

Blue Cross here, too!

[velcro003]

I have Anthem and i am prettty sure that my therapy visits are treated like medical visits: aka i could go as often as i wanted and just pay the co-pay. i used to see two providers in the same session even! lol.

[Elio]

Ok, how does one get therapy visits treated like medical visits? Is it based on diagnosis, billing codes?

So far I've been seeing my T for 2 x wk for over a year now with no problems and yeah, I'd say that they are treated like medical visits in the sense that I pay the co-pay until out of pocket max for the year has been reached and then insurance covers 100%. I expect that I have reached out of pocket max for the year already because of my 3 day hospitalization and surgery. So, really if they are going to cover it, now would be the time to up my sessions. I guess I'm concerned at that concept of "medical necessity". I am far from the crisis place where I was suicidal and I don't need more visits to keep me away from there in general. I could probably even get away with weekly visits from that stand point. However, I would make little to no progress on my social isolation issues and uncertain on my food issues as I still am not able to manage those over the long term. Would that constitute medical necessity though? And does my food issues even meet the criteria for an official eating disorder. I think they do but doesn't match exactly.

Do you know if your T has had to submit treatment plans, official dx, and progress reports? If yes, have you preferred to know what was in those reports or prefer not to know? Does it matter to you?

[velcro003]

i don't know any specifics, but i do know that my T says my insurance is good and i think she just submits claims after every visit and i've never noticed a diagnostic code. no progress reports or anything like that.

i know the plan treats it like medical visits is because it lists behavioral health under the umbrella of medical visits with no limitations.

[Elio]

Originally Posted by velcro003

i don't know any specifics, but i do know that my T says my insurance is good and i think she just submits claims after every visit and i've never noticed a diagnostic code. no progress reports or anything like that.

i know the plan treats it like medical visits is because it lists behavioral health under the umbrella of medical visits with no limitations.

How often do you see your T?

[feralkittymom]

Yeah, I have Anthem, too, and behavioral health falls under the medical umbrella. I don't need a referral or anything. No limits on sessions except only one hour per day. All claims must have a diagnosis code to be processed, but not all codes are "mental illness." Usually "adjustment problems" is the least serious and stigmatizing, so that's what my T used. She's told me that she's never been questioned or challenged on any of her claims and she does not need to submit any sort of progress reports.

[Wonderfalls]

They do have to use a diagnostic code to get paid, whatever insurance you have. My former T/pdoc just used adjustment disorder too. I think the new ones go with bipolar.

[LonesomeTonight]

Originally Posted by Wonderfalls

They do have to use a diagnostic code to get paid, whatever insurance you have. My former T/pdoc just used adjustment disorder too. I think the new ones go with bipolar.

Mine uses the one for Major Depressive Disorder (he knows I also have anxiety, but said he was just submitting that one).

[velcro003]

Originally Posted by Elio

How often do you see your T?

my current T, is just once a week. My last T, I saw her and an EMDR T in the same office for a few months until I felt comfortable seeing the EMDR T on my own. It was never a problem paying them both.

Originally Posted by feralkittymom

Yeah, I have Anthem, too, and behavioral health falls under the medical umbrella. I don't need a referral or anything. No limits on sessions except only one hour per day. All claims must have a diagnosis code to be processed, but not all codes are "mental illness." Usually "adjustment problems" is the least serious and stigmatizing, so that's what my T used. She's told me that she's never been questioned or challenged on any of her claims and she does not need to submit any sort of progress reports.

Yeah, i think mine uses something like adjustment disorder as well.