[Razzleberry]

Anyone else run into this problem? What do you do?

I have a while - but there is a limit of 60 visits per LIFETIME and 30 visits per year. If I go weekly, that is nowhere near enough. And I think I may need therapy and meds for much longer.

The good part is, I'm seeing a psych nurse practitioner - which I resisted at first! But she does both meds & therapy in one visit. So I don't have to see two people.

What do I do when I run out of visits???!!!! I know I still have a year or so, but I'm already scared.

We probably make too much to qualify for sliding-scale - we are in the middle-class range where we make too much to get help, but not enough to afford everything!

[splitimage]

Razzleberry,

I'm sorry - I don't have any advice for you. Limits really suck. My insurance only covers $500 / year of psychologist visits which is like 3 sessions, so I'm paying out of pocket for my therapy - it's my second biggest expense behing rent every month. There's just a bunch of stuff I don't do, so that I can stay in therapy.

One thing to look at - I'm pretty sure that psychologists, not sure about CPN"s, are tax deductable as a medical expense in the US. You'd have to check with the IRS to be sure, but I remember looking into it when I was contemplating a transfer to the US a few years ago. That might at least help make it less painful.

You might also see if you can find a T who works on a sliding scale, geared to income.

Good luck.

--splitimage

[LAS112]

I have a limit too, I think it's 20 sessions including an assessment. The limit on visits is ridiculous. My T is in private practice so he's pretty flexible. I make decent money (not great, but enough that I wouldn't qualify on income based things) but my T just told me the rate my insurance pays him and told me to figure out how much of that I can afford and to let him know. He said to consider my other expenses too. Maybe if you talk to your T in advance, he can work with you on it. I read somewhere, and I can't remember where, that T's can't charge you anymore than what your insurance would pay, so if your insurance approves $65/visit to the T (including your copay) then your T can't charge any more than $65. I think it was in a Code of Ethics for LCSW's but I'm not for sure.

[emilyjeanne]

We can fight back against insurance companies.

Check out this website.... http://www.timothyslaw.org/

In NY Timothy's law was enacted to end the discrimination practice of providing unequal insurance coverage based on diagnosis. It mandates that insurance providers covering any health care services must also provide coverage for mental health and substance abuse services, and that coverage and cost must be "on par" with all other health care services under such a policy.

Depending on what state you live, check out the state insurance department website to see if you are covered.

[sunrise]

Razzleberry, I see a PNP and she bills some visits as "meds consultations" or something like that, and when I stay longer and we talk more, she bills as "psychotherapy." The latter are taken out of my mental health visit allotment that insurance covers, but the strictly meds consulations come out of my regular medical health coverage, not mental health. So even though my mental health visits have a yearly cap, I could see this PNP many more times if she billed those visits as medical. Anyway, I'm wondering if your plan is the same, and you could get more visits with the PNP if she bills them as medical instead of mental health visits? Maybe, if you know her well, and explain the situation, she would be willing to bend a little and bill a psychotherapy visit as medical. A lot of T's will bend the rules in these ways to get around some of the obnoxious insurance rules.

My regular T is not reimbursable by insurance at all, so I understand your dilemma. I pay him 100% out of pocket because he is worth it to me. I can't see him as often as I'd like, but right now in my life I need his services, so I am using some of my savings. I'm lucky to be able to do that and I know not everyone has those reserves.

You might be able to get your PNP to only bill your insurance for every other session and have you pay out of pocket for the ones she doesn't submit to insurance. That way you could spread out the cost over the year, instead of using up all your covered visits in the beginning of the year.

I have never heard of a lifetime cap on mental health visits. That's terrible! The only think my plan has a lifetime cap on is orthodontia. Everything else resets at the beginning of he year. Do you have a choice of insurance plans where you work? If so, since the new year is coming up, maybe you can change to a different insurance carrier so you can escape this lifetime cap. It seems really unusual to me. And terrible!

[Rapunzel]

Make the most out of what you have, and then when you get close to the end of what insurance covers, you will have the best case possible to petition the insurance company for additional coverage. Usually the therapist can ask, and has to explain convincingly why more treatment is needed, but those requests do get granted. I don't know what percentage of them, but don't give up because it can happen.

Also, a lot can change in a year. The insurance company could change its policy. You could have different insurance. Your T could decide to offer a sliding fee. You could be cured! (well, it's a possibility too, right?) Just make the most of now, and worry about down the road when it happens. Oh, but do talk to your T about your concerns and fears about this issue too. Ok?

[DoggyBonz]

Hi,

I'm not sure if this was said and I am also not sure if it is state by state but I know in MA there was a law passed that said if the problem is biological the insurance companies can't limit the number of visits. It might be worth it to ask your doctor or check with your insurance company about biologically based and if so what they consider to be them. You can also probably find it on their webiste.

For me it has been a lifesaver - good luck.

[Razzleberry]

I did think of one option. The reason I got this new insurance is that I lost my benefits at work - party because I've taken so much time off for hosptializations.

My old insurance was WONDERFUL - all mental health counted just like medical, $25 copay, no approvals, no limits. The price of Lamictal was steep, but once it went generic it was only $7.00. I LOVED that insurance.

The 30/60 limit should get me thru to at least the middle of 2009. By then I should be more stable and back to full-time and not taking so much time off. Maybe at that point I can BEG my employer to get me back on their coverage. I've seen the EOB's that say how much my Psych Nurse gets paid - and we could not cover that at all if I'm going weekly.

Maybe if I get more stable I can go twice a month or even once a month. But right now, I really need it weekly. I've only been out of the hospital for a month - I was in there off & on from June - August, severely suicidal 3 times in 6 weeks.

I will check into that law. I completely agree that mental disorders are MEDICAL issues and should be covered just the same. If they cover a brain tumor, they should cover a brain disorder. It's the same organ. I hate how things work.

And hopefully my psych nurse just puts the Bipolar II diagnosis on all my stuff - I may be royally screwed if she puts the Borderline Personality Disorder too. Because some insurances - possibly mine, I don't know - think it's untreatable and thus do not cover it. Yikes. I'll cross my fingers on that one.

I can hardly believe they have a LIFETIME limit of 60 visits. I have 30 per year & then I pay out of pocket for therapy & group therapy.

Re: bipolar or borderline on ins. form. I would try to stay away from borderline being written as a dx as I think it is axis II & not considered a "mental illness" but a "personality disorder" & so that is not biologically based so not considered a "medical" problem. At least that is my understanding. Plus the stigma against borderline is so huge--even in the mental health professionals. You wouldn't believe what some of them say in meetings (I'm in there as a volunteer in the support group in the women's jail so I go to the "facilitators' training meetings with the therapists). I was shocked. Borderline is difficult to treat (statistics say an average of 10 years of intensive therapy--DBT--is needed), but still, these people did not CHOOSE to be this way.

I'm in a DBT group with all borderline except me (bipolar 1). I fit right in!--Suzy

[sunrise]

Originally Posted by Razzleberry

And hopefully my psych nurse just puts the Bipolar II diagnosis on all my stuff - I may be royally screwed if she puts the Borderline Personality Disorder too. Because some insurances - possibly mine, I don't know - think it's untreatable and thus do not cover it. Yikes. I'll cross my fingers on that one.

Can you ask her what she is putting down on the insurance forms?

[kim_johnson]

I guess one issue is about whether the number of sessions is PER DIAGNOSIS PER LIFETIME or PER LIFETIME SIMPLICITOR. That makes a considerable difference because there is much elbow room when it comes to diagnostics (as there also is with a number of other (general) medical conditions.

> In NY Timothy's law was enacted to end the discrimination practice of providing unequal insurance coverage based on diagnosis. It mandates that insurance providers covering any health care services must also provide coverage for mental health and substance abuse services, and that coverage and cost must be "on par" with all other health care services under such a policy.

My health insurance company excludes neurology so as to qualify as having 'treatment parity'. Psychiatric and addiction issues are thus treated comperably to other (general) medical conditions - to neurological conditions, for example, which is to say that there is no coverage at all.

One concern with 'treatment parity' is that it will come about by way of more (general) medical conditions coming to be equally excluded... Maybe... 'Treatment parity' isn't in the interests of consumers after all...

Is the insurance covered by your job or do you purchase it independently? Might be worth looking into alternative insurance options if you pay for it yourself. Check out exclusionary criteria in particular (e.g., for a particular diagnosis that has been treated in x amount of time since there is scope for alternative diagnosis with psychiatric disorders - as there is for some (general) disorders).

Alternatively... I've heard of people seeking out alternative employment opportunities on the basis of health insurance coverage. That might be another options... Sounds like you have a year or so to decide???

[bchlyn]

when i run out of visits... my t has to fill out some paperwork... and i have to answer some really intrusive questions... which i hate... but they always add more visits... i have really good insurance... but because my t isn't a preferred provider i have to pay 50% which is a lot for me... so my t gives me a 20 dollar discount... good luck...lyn

[ECHOES]

I don't use the insurance benefits. Mine are extremely limited and I don't like those people having access to or putting my intimate information into any treatment records.

I enjoy being completely free and independently paying for therapy. It is a huge struggle but well worth it. My therapy is only between my therapist and me.

[little*rhino]

stupid new board.. can't make the quick reply work.. grrr

anyways... cold reality: my insurance pays for TWO visits per year.

[whales75]

HI
Just as a tip, You need to ask your insurance carrier, if your plan is self funded or fully insured. Fully insured plans have to follow state mandates where you reside, self insured ones do NOT, they only follow ERISA..

Even if it's self insured, go through the appeal process. There is one if it follows ERISA ( a federal law)... Sometimes, the insurance company will allow an alternate benefit exception as it's more cost effective for a borderline to go to outpatient therapy vs inpt or thru the ER.. I appealed twice with mine and was granted extra visits.. My therapist had to write a letter of medical necessity but it was worth the extra effort. Hope that helps..

Originally Posted by Candika

my insurance pays for TWO visits per year.

Okay, THAT makes NO sense! TWO visits?? What on earth are you supposed to accomplish in TWO visits!?!