Virtual Substance Use Disorder Treatment
When it comes to substance use disorders, stigma remains a strong factor in causing people to avoid seeking care. A virtual environment can help remove barriers such as stigma and lack of transportation to treatment. As a Regence member, you may have access to:
Virtual addiction treatment for members ages 18 and older, including medication-assisted treatment for opioid use disorders. Along with MAT, they offer support through peer coaching, care coordination and other recovery tools.
Virtual and in-person treatment for substance use disorders and mental health conditions. Treatment can include MAT, psychiatry, psychotherapy, nursing care management and community support services.
Not all telehealth options are available on all plans. To see if these virtual treatment options are in your network, sign in to your account and go to Find a doctor. Choose Places by name and then type in the name of the provider. You can also find out by calling or chatting online with Customer Service.
Heres The Thing Therapy Works
Deciding to see a therapist can seem like a daunting task, especially considering the cost and the complicated world of health insurance. However, the benefits of therapy cannot be overstated its been proven to reduce depressive symptoms, and can provide a safe space for you to learn more about yourself. So if you feel like your mental health is having a significant impact on your life, consider looking into therapy. It can be scary, but in the end, it may be worth it.
The greatest benefit of therapy is honestly just the self-exploration and the self-awareness that comes with it, and I think that’s something that everyone can use, Lindsey said.
Yes There Are Exceptions
If your finances are so limited that using insurance is the only way youll get the therapy you need, then please do it.
If your co-pay is too high, please contact community mental health centers or university training clinics that offer discounted therapy.
Getting treatment is always the priority.
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Do Medicare Or Medicaid Cover Ketamine Therapy
Medicare or Medicaid coverage for practitioner therapy is a fee-for-service system, in which a healthcare provider is paid based on the number of services they provide or procedures they provide. With this arrangement, your Medicare/Medicaid or other insurance provider is billed for every test and procedure covered each time you visit your doctor. Many ketamine clinics will work with Medicare/Medicaid plans, but their coverage does not extend to the actual drug or its handling and infusion. Further, because public plans are augmented by individual states, the exact cost coverage will depend on where you live.
In general, however, most clinics with this type of arrangement will bill your insurance provider for the time you spend with the doctor, cardiac monitoring during the therapy, IV fluids and other medications, while you cover the gap. Before going for your ketamine treatment, it is best to check first with your insurer to understand precisely what part of your treatment they will cover.
What Is My Deductible For Behavioral Health
Deductible: this is the amount of money that you are responsible for paying in full before your coverage begins. Deductibles can vary from several hundred dollars to a few thousand dollars. You will pay the full cost of services until the deductible amount is met. After you meet the deductible, your insurance will cover some amount of the cost and your out of pocket cost is either a copay or co insurance.
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Does Insurance Cover Couples Counseling
If youre planning on using insurance to pay for couples counseling, the rule requiring a mental health diagnosis will continue to apply in most cases: One partner must receive a diagnosis for insurance to cover it. Some people feel this has the potential to skew their therapeutic experience.
As with any diagnosis you receive, a mental health condition diagnosis may remain in your permanent record. In some instances, it may be accessed by background checking systems.
Using Your Mental Health Coverage
Check with your human resources department or insurance company for specific details about your coverage. Here are some important points to consider:
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Does Your Health Insurance Cover Mental Health
Mental health care thats expensive to the point of being inaccessible has been an issue for a long time, but it has taken on new urgency during the Covid-19 pandemic. For many people, waiting for insurance companies to get it together is not an option right now. Luckily, you may not have to wait. There are steps you can take to better manage these costs.
- Explore your options. To land on one that will be best suited to your needs, do some good old-fashioned Googling to see what other patients have said about the provider youre interested in. You should also visit each providers website to learn whether or not they accept your health insurance.
- Beware of out-of-network providers that operate from in-network hospitals or treatment facilities. As much as $40 billion a year is spent on patients receiving treatment from out-of-network providers through in-network facilities.
- Understand reimbursement protocols. Some companies provide reimbursement for a range of services, including therapy, medical management, psychological testing services, etc. Check your summary of benefits and coverage to figure out whether yours is one of them.
- Consider online therapy. You may be able to subscribe and pay a set fee per month for unlimited access to a therapist, which could provide a higher level of treatment at a lower cost than paying for individual appointments with an in-person therapist.
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The Mental Health Parity Act Of 2008
The Mental Health Parity and Addiction Equity Act is a federal law that keeps group plans from offering different mental health benefits than they do medical or surgical benefits.
A major goal of MHPAEA and the ACA was to create a system that offers equal coverage for the treatment of both addiction and mental health conditions. Prior to the MHPAEAs passage, 49 million Americans were without insurance, 2% had coverage that didnt offer any type of mental health benefits, and 7% had no substance use benefits.
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Is Massage Therapy Covered By Insurance
The Balance / Sabrina Jiang
Massage therapy can have many medical benefits. It can relieve muscle tension, improve circulation, and help with pain relief, stress, and anxiety.
Massage therapy is considered a part of complementary and alternative medicines . CAM can be used to complement standard medical treatment by doctors when addressing certain medical conditions and situations. According to the Centers for Disease Control and Prevention , 23.5% of American adults spent money on complementary health measures at least once in 2012.
Learn about massage therapy insurance coverage and how to find out whether your provider covers it.
Q: Does Medicare Cover Mental Health Or Substance Use Disorder Services
Answer: Yes, Medicare covers a wide range of mental health services.
Medicare Part A covers inpatient mental health care services you get in a hospital. Part A covers your room, meals, nursing care, and other related services and supplies.
Medicare Part B helps cover mental health services that you would generally get outside of a hospital, including visits with a psychiatrist or other doctor, visits with a clinical psychologist or clinical social worker, and lab tests ordered by your doctor.
Medicare Part D helps cover drugs you may need to treat a mental health condition. Each Part D plan has its own list of covered drugs, known as formulary. Learn more about which plans cover various drugs.
If you get your Medicare benefits through a Medicare Advantage Plan or other Medicare health plan, check your plans membership materials or call the plan for details about how to get your mental health benefits.
If you get your Medicare benefits through traditional Medicare and want more information, visit Medicare and Your Mental Health Benefits . To see if a particular test, item or service is covered, please visit the Medicare Coverage Database.
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Whats The Difference Between In
Depending on your health insurance plan, you will have access to specified in-network therapists and out-of-network providers that accept your health insurance. With an in-network therapist, you will pay a predetermined copay at the time of your appointment, and your insurance company will pay the rest. To know if a therapist is in-network, you can ask the office to check if they accept your insurance.
If you choose an out-of-network therapy provider, expect to pay more for the service since this is not something that your insurance will cover, similar to how medical health service coverage works.
Are Deductibles Included In My Plan
Deductibles for therapy and mental health resources can vary from plan to plan. Some plans require you to spend the entire deductible out-of-pocket before your insurance will pay any claims. This depends on the deductible you selected initially. However, there are some insurance plans that offer separate deductibles for physical health treatments and mental health treatments. It is important to contact your insurance company to determine which deductible setup they have.
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How Do I Find The Right Therapist
The right therapist is one whom you trust and who is effective in treating your mental health problems. However, the right therapist is also one whom you can afford.
To make therapy affordable, you will sometimes need to find an in-network therapist. The most effective way to find in-network therapists is by asking your insurance company for a list of in-network therapists directly.
If you dont have coverage and youre looking for a therapist who can work with you on costs, use a therapist search engine like the one from Psychology Today and look for therapists who offer sliding scale payments. With a sliding scale payment structure, the therapist charges you based on your income, instead of a flat fee or hourly rate regardless of your income.
My Insurance Company Has Only Approved A Certain Number Of Therapy Sessions To Treat My Disorder Is This A Violation Of The Parity Law
The parity law prevents insurers from putting a firm annual limit on the number of mental health sessions that are covered. However, insurance companies can still manage your care. Your plan may say, for example, that after 10 or 20 appointments with a psychologist, they will evaluate your case to determine whether additional treatment is medically necessary according to their criteria. This kind of management is generally permissible under the parity law if the company uses the same standards for determining mental health coverage as they use to decide what medical services to cover. But if the company terminates or reduces care much sooner than your psychologist thinks is appropriate, that could indicate a possible violation of the parity law.
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Mental Health Parity Law
In 2008, federal lawmakers passed the Mental Health Parity and Addiction Equity Act , which basically says if health plans do offer mental health coverage, the benefits must be comparable to medical coverage. For example, if you have a $60 copay to see a specialist such as a dermatologist, your copay for therapy must cost the same or better. The law applies to employer-sponsored health plans for companies with 50 or more employees, individual health plans purchased through the health insurance marketplace under the Affordable Care Act, and the Childrens Health Insurance Program . The federal parity law, however, does not apply to employer-sponsored plans for 50 or less employees, some state plans , and Medicare however, Medicare does offer mental health services.
Why Do So Many Therapists Decline To Accept Insurance
The primary reason therapists dont accept insurance is economic: rates of reimbursement by insurance companies are deemed too low to sustain a private practice. For clients seeing a therapist who does not accept insurance, asking whether a therapist offers a slide-scale fee and seeking partial reimbursement from an insurance company for out-of-pocket expenses are two ways to reduce the cost of therapy.
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Mental Health Services Typically Covered By Insurance
Although treatment coverage varies tremendously, one thing remains consistent: for health insurance to cover therapy, it must be medically necessary. So, you can get mental health services like:
- Psychiatric emergency visits
- Outpatient sessions with psychiatrists, clinical social workers, and clinical psychologists
- Online therapy
The extent of coverage for specific mental health treatment, such as the length of rehab or number of outpatient visits, varies from plan to plan. So does the coverage and out-of-pocket cost for any medications you might need to treat your condition, both as an inpatient and outpatient.
Which Mental Health Services Are Usually Covered By Health Insurance
When deemed âmedically necessaryâ by a mental health professional, services that may be covered by insurance include:
- Psychiatric emergency services
- Co-occurring medical and behavioral health conditions, such as coexisting addiction and depression. This is often referred to as a dual diagnosis.
- Talking therapies, including psychotherapy and cognitive behavioral therapy
- Unlimited outpatient sessions with a psychiatrist, clinical social worker, or clinical psychologist. In some instances, your insurer may cap the number of visits youâre allowed annually unless your provider states in writing that theyâre medically necessary for your care.
- Telemedicine and online therapy
- Inpatient behavioral health services are received in a hospital or rehabilitative setting. Your plan may limit the length of your stay or cap the dollar amount theyâll pay for your care per benefit period.
- Addiction treatment
- Medical detox services, including medications
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Why Wont My Mental Health Provider Accept My Insurance
Mental health care providers can choose whether or not to accept insurance. Although some do accept it, many do not.
Why? One reason many therapists and counselors give is insurers dont pay them very well for their services. According to the American Psychological Association, “many insurance companies have not increased the reimbursement rate for psychologists in 10 or even 20 years despite the rising administrative costs of running a practice.” Others have even reduced their reimbursement rates in that time.
Also, insurers have made it increasingly difficult for counselors and therapists to get paid. That’s another reason many mental health care professionals balk at accepting insurance.
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Legal Exceptions For Employer Health Insurance
Smaller companies do not have the same resources and liabilities as companies with 50 or more full-time employees. For this reason, companies with under 50 full-time employees are not mandated to provide health insurance to their workers.
If a company of this size does provide health insurance, it must include coverage for substance use disorders, regardless of how the company purchases employee coverage.
What If I Want To See A Therapist Who Is Out
You may prefer to find a therapist through personal recommendations from trusted friends or family members, or your primary care doctor. However, those therapists might not be in your insurance network, or might not accept your insurance.
In that case, you can still use your mental health benefits if you have coverage for out-of-network providers. But youll probably pay more. In the sample chart above, youd pay only a $35 copay for an office visit with an in-network therapist. But out-of-network, youd pay 40% of the providers fee yourself.
Some therapists dont accept any insurance, or might not accept your insurance.
One challenging thing in some areas of the country is that mental health care is often still provided by solo practitioners, says Bufka.
Therapists who handle their own billing might not accept insurance or limit the number of plans they take. If you see such a therapist, youd have to pay for the visits yourself, then submit a claim to your insurance company for reimbursement.
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Blue Cross Blue Shield
Today, thanks to the Affordable Care Act , most Blue Cross Blue Shield insurance plans will cover therapy. If you have a plan that started before 2014 when the ACA was enacted your plan may not cover mental health services. There are some additional caveats to this as well. Blue Cross Blue Shield only covers evidence-based services like psychoanalysis. Sessions with a life coach, career coach, etc. are not covered.