Am I Covered by My Insurance??

It’s a new year!! Do you know how to check your mental health benefits and ask the right questions? Read on for more!

2020 IS HERE!!  Read on for common questions and answers regarding insurance coverage. 

Do we know what our ‘Mental Health (behavioral health) and Substance Abuse benefits will be within our health insurance benefit packages? 

This question can be answered by either your Human Resources department, reading about them in your health insurance benefit package (often found online), or by calling your insurance policy member services department (phone number is typically on the back of your card) can help pave the way for a smooth mental health transition from 2019 to 2020 without too big surprises. Our billing department is also happy to assist in providing answers as well once you become a formal client of our office. 

Do we know if our policies fall within the parameters of the Parity Law? 

The Paul Wellstone & Pete Domenici Mental Health Parity & Addiction Equity Act (a.k.a. mental health parity law or federal parity law) was passed in 2008. This requires certain policies to charge the same co-payment for mental health office visits as medical doctors are charged instead of a higher specialist rate.  This is only required for companies with fewer than 50 employees, Obamacare / Exchange policies, CHIP / ALLKIDS. This does not apply to private policies. 

Do we know if our mental / behavioral health benefits are directly through our known insurance policy (e.g., Blue Cross Blue Shield or United Healthcare) or are our benefits provided from a third-party intermediary company such as Optum, ComPsych, or New Directions Behavioral Health, etc.? 

This is very important to clarify.  Many people assume that all Blue Cross Policies are the same - this is not true!  Some Blue Cross plans are provided by a third-party intermediary company, and benefits can vary WIDELY.  Common questins to ask of your policy include:

  1. Do we know if our mental health provider is an In-Network provider or an Out of Network provider with our policy? 
  2. If our preferred provider is an Out of Network provider can we obtain an In-Network exemption directly from our policy for our provider to use our In-Network benefits instead? 
  3. How much can these options save us? 
What happens when myself or a family member on my plan sees more than one provider in the same office but each one is set up differently with my policy? Are we aware we can use both the medical and mental health aspects of our policy at the same office with completely different benefit packages? 

Here at Silver Linings you may have a Blue Cross Blue Shield policy and see one of our psychologists. Those services would fall under your mental / behavioral / substance abuse benefits provided through BCBS’s contract with an intermediary company, such as New Directions Behavioral Health who has their own benefit package. You can have psychological testing services AND THEN can be referred to speech or occupational therapy. Those "habilitative therapy services" would fall under the medical benefits of the policy and incur their own out of pocket expense to you. Many people assume that if they're testing is covered, that other therapies within our office are covered too - unfortunately, we can't control these differences and often the coverage is different.

Why do I have to become a patient and be seen for my first appointment before detailed information is provided?

Unfortunately, and as you can see above, determining mental and behavioral health benefits is complicated.  It can often be a very time demanding process to determine the full ins-and-outs of a particular plan.  It is for this reason that we do ask for paperwork ahead of time, and try our best to have such information available in time for your first appointment. 

What happens if my plan covers, but I still have a high deductible or the copays are still unmanageable for my income?

Sometimes services are just expensive. The only way around that is to set up payment plans that can complement your monthly budgets. At Silver Linings, we are very happy to offer flexible payment plans to meet your budgetary needs - this includes for weekly therapy costs! This is most beneficial when multiple individual providers are seen within the same office yet for different services.  We try our best to combine all service fees into one manageable monthly payment, when possible. 

As always, we are here to answer your billing questions. Once you come in for your first appointment, we can provide more detailed information on your specific plan.  

Cheers to a bright and mentally well New Year!


Angela Holzheimer

Office Manager, Billing Department

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