I just spoke with my insurance company yesterday and they told me that I am covered for 50 sessions for the year. I was going to two sessions a week from January to mid-June. I just figured out that I'm close to the 50-session mark. I see my T on Tuesday and will talk to him about this. Has anybody else run into this problem? Do the insurance companies usually end up allowing more than 50 sessions? Just what I need -- something else to stress about!

So, I MUST BE CURED! Surely, the insurance company would allow more sessions if they felt I needed them? Let's have a celebration. One of us has finally made it out, lol.

My insurance covers 30 visits a year. I burned through those really quickly, since I go twice a week.

Now I pay out of pocket. T gives me a reduced rate, but it's still not exactly cheap!

Good luck, Sol. I do NOT get why insurance coverage is so ridiculously limited for mental health!

[younotme]

I only get 24 visits a year, once every 2 weeks. It stinks, and my T does not offer reduced rates.

[sunrise]

Soliaree, 50 covered psychotherapy sessions is quite generous. It has nothing to do with whether you are cured or not but what your plan allows. With my first T, I got 20 covered sessions, and she told me the insurance company was quite firm on this (she had worked with this insurance a lot before), and if it seemed like I was going to go over 20, she and I would work to alleviate some of the burden. For example, she said I could pay her out of pocket every other session and she would bill insurance for the other sessions. That way I wouldn't be covered for the whole year, but half covered for the whole year and I could spread the "out of pocket" out over a whole year. I didn't have to do that with her, but it was a nice offer I thought. Maybe you can pay some out of pocket now with your T and then use up some of the still covered sessions later in the year.

With my current T, my insurance doesn't cover anything, so I pay completely out of pocket.

Good luck working this out. Insurance hassles are a pain.

Yes, they are a pain. It looks like I get more than some people do. It just infuriates me! It's like they think they are paying for an unnecessary service or something. They totally have no clue.

[lauren_helene]

Just an FYI whoever you have insurance through has a contract with the insurance carrier and that is what governs the number of visits etc.

My first HMO almost sent me into a black hole when they started giving T a hard time about twice a week. I had about 50 sessions but that included p-doc...but if the contract from the employer says hey we don't really want to get to those 50 sessions...it could be less.

My husbands policy which we've been on over a year and I love is unlimited outpatient mental health...POS Open Choice Plan and it rocks.

Restrictive plans mean that T has to justify your sessions at one point or another or an increase in frequency...unfortunately, the guidelines hurt clients big time as it did for me awhile back.

[MissCharlotte]

Wow,

It seems that these plans are really all over the place and yes, Soli, I agree--it's as if it's an optional service!

I get 60 visits per year, but also go 2x a week. I have not submitted every single visit so I can stretch out the pain a bit. T is a "non participating provider" so I pay him each week and then I have to seek out reimbursement from the ins. co.

Peace

[pachyderm]

> I do NOT get why insurance coverage is so ridiculously limited for mental health!

What the heck? It is because they do not want to PAY!

I actually have some sympathy with the insurance people, though, because "mental health" treatment is so uncertain! Not like much of physical health treatment, where causes and outcomes are better understood (often).

[little*rhino]

here you can get T services covered for free through mental health, but bc mental health always gets the short end of the stick it usually means underfunded programs, etc. It's often the residents who will be leaving in 6 mos or whatever. You wait and cannot choose when you see them.. and there is only straight vanilla CBT. Great.

people, insurance or not, seem to think that T services are not as necessary because they have not needed them themselves.

we can't possibly have a mentally healthy society.. that would be wrong.

50 is generous from what i understand. Please note, that most Canadians only have drug/dental insurance privately and because of that there is less regulation... so the insurance companies can do ridiculous things. My plan gives me TWO sessions per year. Two. Wtf can anyone DO in two sessions? i barely knew scuffy's name in two sessions.

i am so sorry this has happened this way soli.... is out of pocket a possibility?

much love

[Merlin]

i have $500. and each session is covered 80%. i think i got 4 sessions.

[sidony]

I'm jealous of the 50 sessions!!!!!!!!!

I only get 20. I think the first 5 are covered fully, then the rest at 50%. Or something like that. I'll pay out of of pocket for the vast majority for the year. And yeah, it sucks. :-( :-( :-(

Sidony

[sidony]

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sidony said:

I only get 20. I think the first 5 are covered fully, then the rest at 50%.

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Oh and that means 50% of the "usual customary rate" specified by the insurance company. It's roughly $35 (on a $135 session).

[Gracey]

I am loving the fact that my counselor is a professor at the local college and I pay their rate for "community" mental health service, which is $10 a pop. No insurance hassle. I have to be flexible though, b/c her schedule changes somewhat each semester, but we've managed to make it work by swapping days this last time. I'd be up the creek w/o a paddle if I had to depend on my ins.

On a note. . .I got around the whole pdoc bit after I was STABLE on meds by getting my GP to script them for me. He called pdoc, they chatted, GP started writing for me. If he had a question, he'd call pdoc again, maybe run a couple tests, but b/c I didn't have to deal with pdoc or "mental health" side of insurance, it freed up my visits for the counselor. I don't do meds now. . .but it worked while I was on them.