Questions About Insurance

Insurances Accepted:

  • Aetna
  • Anthem BlueCross BlueShield
  • Carefirst BlueCross BlueShield PPO
  • Cigna
  • Premera

How do I know if my health insurance plan provides mental health coverage?

Check your description of plan benefits — it should include information on behavioral health services or coverage for mental health and substance-use disorders. If you still aren't sure, ask your human resources representative or contact your insurance company directly.

My mental health provider won't accept my insurance, even though I have mental health coverage. Why not?

Psychologists and other mental health providers can choose whether or not to accept insurance. Unfortunately, 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. Other companies have recently cut their reimbursement rates. As a result, some plans have trouble attracting mental health professionals to participate in their networks. If your options seem limited and your insurance is provided through your employer, you might consider discussing your concerns with your human resources representative. He or she may take that into consideration when negotiating your company's plan with insurance companies in the future.

My insurance covers out of network providers. What do I need to do get reimbursed for psychotherapy services?

If your health plan covers out of network providers for mental health services and you are seeing a mental health provider who does not accept your insurance, complete your insurance claim form and submit it along with the mental health provider's invoice to get reimbursed. If you are unsure about your health plan's claim procedures for out of network providers, contact your insurance company.

Who should I talk to if I think my insurance company is violating the parity law?

If you have concerns that your plan isn't complying with the parity law, ask your human resources department for a summary of benefits to better understand your coverage, or contact your insurance company directly. Your human resource department can provide you with information about your coverage and may be able to put you in touch with a health care advocate who can assist in making an appeal. If other employees are having similar issues, your HR department may wish to keep track of the problems and work with the insurance company to ensure that benefits are meeting employee needs. If you do not have an HR department or if your insurance is not provided by your employer, you may wish to speak with the insurance company directly. To reach out to your insurance company, check for a customer-service number on the back of your insurance card. If you obtained your insurance through an insurance exchange, you may be able to get help from your state insurance commissioner.If you still have unanswered questions or wish to file a parity complaint, visit the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) Consumer Assistance web page — from there you can click on “Ask a Question,” “Submit a Complaint,” or “Report a Problem.” You can also call the EBSA toll-free consumer assistance line at 866-444-3272. The federal government's Consumer Assistance Program webpage is another good resource.

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:

  • Check to see whether your coverage uses provider networks. Typically, patients are required to pay more out-of-pocket costs when visiting an out-of-network provider. Call your insurance company or visit the company's website for a list of in-network providers.
  • Ask about copayments. A copay is a charge that your insurance company requires you to pay out of pocket for a specific service. For instance, you may have a $20 copay for each office visit. In the past, copays for mental health visits may have been greater than those for most medical visits. That should no longer be the case for insurance plans subject to the parity law.
  • Ask about your deductible. A deductible is the amount that you must pay out-of-pocket before your health insurance makes any payments. Depending on your deductible, for instance, you may have to pay $500 or even $5,000 out-of-pocket before your insurance company will begin making payments on claims. As a result of the parity law, your deductible should apply to both mental and physical health coverage.
  • Talk to your provider. When you call to schedule an appointment with a mental health provider, ask if he or she accepts your insurance. Also ask whether he or she will bill your insurance company directly and you just provide a copayment, or if you have to pay in full and then submit the claim to your insurance company for reimbursement. If your provider does not accept insurance, ask about his or her payment policy. 

Credit given to the American Psychological Association

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