When I had my first baby, I was completely clueless about adding her to my health insurance. In the haze of sleep deprivation, I simply assumed that she would automatically be covered once I informed the company of her birth. Before I knew it, I was in a panic realizing that she was uninsured after 30 days. If I hadn’t done the research, I would still have been in the dark about the process. Let’s face it, health insurance is complicated. Like tax law, it often requires an expert to explain the ins and outs and how to take advantage of your plan.
When selecting your coverage for mental health benefits, it’s important to be aware that Federal laws now require some level of coverage for mental health services. This can vary depending on your specific healthcare provider and plan. As an increasing number of physicians and mental health clinicians are leaving insurance networks –including ours–, it’s important to do your homework and apply the math skills you learned in high school!
Here are some of the things I have learned being an insurance provider (and consumer):
You don’t need to get insurance through your workplace: There are many options for purchasing private health insurance. You can go directly through the Insurance company’s website or your state health insurance directory website. Depending on your household income, you or your family may qualify for discounts. A note: before opting for employer-provided insurance, shop around to see if you can get better coverage for the same or a lower cost. When employers negotiate rates with insurers, premiums are often calculated based on the average age of employees. If you are younger than your co-workers, your premium could be less expensive if you purchase on your own.
When choosing a plan, consider what benefits you plan on using: Do you see the doctor often? Do you anticipate or have any current health conditions? Do you only see a doctor once a year? This can help you determine the right level of coverage for you.
It might be worth it to pay a higher monthly premium to have more flexibility: If you want the freedom to choose what doctors you see or how often you see them, it might be worth it to choose a plan that has out-of-network coverage. This is where calculations are especially important. For example, if an out-of-network therapist charges $205 per session, consider what your reimbursement rate would be. Calculate the total annual premium of each plan vs. the difference in reimbursement. If your premium goes up $150 a month, but the reimbursement you would receive is $250 a month, it’s likely worth it to choose a higher-level plan like a PPO.
Dental and Vision plans work differently: For dental coverage, dentists are only allowed to perform certain procedures or utilize specific substances for fillings, crowns, etc. based on what your plan will cover. If you choose to pay out-of-network, you may have more options and flexibility. For vision plans, often times specific contact brands or upgraded lenses for glasses might not be allowed. Consider the monthly premiums for these plans vs. how much you would really spend out-of-pocket for eye exams, glasses, etc.
Family Plans might not be less expensive: When pricing out my own insurance when adding my daughter, I learned that she could have her own plan as the primary plan holder for a SIGNIFICANTLY lower cost than adding her to my insurance plan. My spouse and I also realized that it’s more affordable to have individual plans than a family plan. Call your insurance provider to explore all your options.
Medicare is also complicated to navigate: There are free state insurance helplines that you can call for support in choosing your Medicare coverage when the time comes. Be aware: If you wait to add additional portions of Medicare after the initial enrollment period, you will have to pay penalties to add additional coverage such as prescription drug coverage. This can get very cost-prohibitive.
It's as difficult for a medical office to get answers from insurance as it is for a consumer: Before I became an insurance provider, I believed that there were special phone lines where providers received immediate answers and didn’t have to wait on hold for hours like “common folk” – this was not at all the case. Insurance companies make it as difficult for providers to get answers and, oftentimes, work even harder to receive reimbursement payments. Insurers can even “claw back” payments from years prior without warning, leaving providers to repay significant amounts.
Ultimately, make sure you are doing extensive research when choosing an insurance plan for yourself or your family. It can save you a great deal of money and headaches in the future.
If you are considering using out-of-network benefits for mental health support, contact us for more information.