How to Find Out if Therapy is Covered by Your Insurance Company in Palm Desert

Lauren Fox, LCSW, Therapist Palm Desert can help you determine if you are using in network or out of network benefits to access mental health services.

Thoughts from your Therapist Palm Desert

Navigating Therapy In Palm Desert

Many people know that they have or do not have medical insurance, but not everyone knows exactly what that insurance covers. This blog is meant to walk you through the process of learning if mental health therapy is covered by your insurance company.

Lauren Fox, LCSW, Therapist Palm Desert can support you in calling your insurance company to access information about your mental health benefits.

How To Begin in Palm Desert

Look on the back of your insurance card and you should see a few phone numbers as well as a link to the company online member portal. You can choose if you are in the mood to call or look get online and will need to have the following information in order to verify your benefits:

1.     The username and password of the online portal to see your account information (you may need to set this up if you haven’t already)

2.     The name and birthdate of the plan holder (if this is not you, it could be your spouse or parent if you are under 26 years of age)

3.     The member ID and/or plan ID (usually can be found on the front of your insurance card)

Once you have entered that information into the phone system or the online portal, you can look for/ask what your mental health benefits are. In many cases, you will be told what your in-network as well as your out of network benefits are. These should be reflected as both an in network amount of therapy sessions, co-payment/co-insurance or deductible as well as an out of network amount of therapy sessions, co-payment/co-insurance or deductible. They will probably be very different numbers.

What if you want to see an out of network mental health provider?

You have a few options if you’d like to work with an out of network provider. The first is you can work with them and not use your insurance benefits at all, just pay out of pocket privately without involving your insurance. Sometimes clients opt for this option because they are not interested in using their insurance benefits and/or don’t want their insurance company to have access to their mental health records.

Another option is to double verify that you have the correct information regarding your out of network benefits and use those funds to see an out of network mental health provider.

An example of this might be: your out of network deductible is $2000 and then you are reimbursed by your insurance company 60% of the session cost.

What this looks like in the real world:

Continuing with the example posted above, if the out of network mental health provider you are wanting to see charges $200 per session, then the first 10 sessions you see them will apply toward your deductible and every session after those ten sessions will be reimbursed by your insurance company for 60% of the session. You will pay your therapist $200 at each session and then submit your receipt of therapy services to your insurance company after each session or every month or whatever cadence you decide to submit your receipts to them. Once you have had your ten sessions and met your deductible, you will receive a check back from your insurance company for $120, making the cost of seeing your out of network mental health provider $80 per session. The benefit of this option is you are able to use your mental health benefits that you pay into through your plan holder’s insurance plan. Additionally, in meeting the deductible in those first ten sessions, you are also able to see additional out of network providers at that 60% reimbursement rate for the duration of your calendar year or annual plan.

What if my plan doesn’t offer any out of network benefits?

Some insurance plans do not offer any out of network benefits and so you will want to verify that with your plan if you do not see out of network benefit information on your portal dashboard or within the phone system. If this is the case and you do not see any in-network therapists you are wanting to work with or who have space on their caseload to see you, then you can contact your insurance company and tell them that. You need help and want to use your benefits, so what are they going to do to support you and connect you to help? What other options are available to you in this instance – those are answers for your insurance company to provide to you if in-network mental health support is not accessible.

What if you just had a baby and you want to know if you’ve met your deductible?

If you are finding it hard to verify your benefits, reach out to me! As a therapist in Palm Desert, I am often navigating insurance systems. In most instances, I am able to verify your benefits with your consent. You can also ask your partner or other supportive person in your life if they could help you with this process so that you can get the help you need, now.

What if you have already met your deductible for the year?

You will want to double verify with your insurance company that you have met your deductible, as well as when the calendar resets for a new year…is this January 1 of each year or July 1? This is important information to help you make an informed decision as to how to proceed with out of network mental health therapy.

What will it cost for me to feel better?

Although therapy is specific to each individual, your therapist Palm Desert should be able to provide an average amount of sessions most clients fall under to give you an idea of what your situation could warrant. If you are struggling and fearful that not receiving therapy could be detrimental, think about what the cost to feel better means to you. If investing in your mental health changes your life, what price would you pay?

Would a support group be a good place for me to start?

Yes! It can absolutely be a good place for you to begin. Especially for new mothers, an opportunity to come together with other new mothers and their babies and discuss in the real world what is happening in all of your lives can be a wonderful therapeutic intervention. Some women enjoy attending group and weekly individual therapy as it provides the opportunity to socialize and connect in a group while also processing unique, individual specific events in therapy sessions. BabySpace Coachella Valley is one local option for new mothers to attend.

What if you still have questions?

If you are wanting support in determining whether you can use your insurance benefits to see your Holistic Therapist in Palm Desert or Palm Springs, reach out to me! I would be happy to help you get more clarity on your specific situation. Feel free to call me at 805-930-9355 for a free 15 minute phone consultation. If you are looking for help with pregnancy, postpartum, pregnancy loss, infertility, birth trauma or hypnotherapy, you can read more about how I can help within this website.

Serving the Coachella Valley and surrounding areas, including: Palm Springs, Cathedral City, Rancho Mirage, Indian Wells, Thousand Palms, Palm Desert, La Quinta, Indio, Bermuda Dunes, Coachella, Thermal, Mecca, Desert Hot Springs, Yucca Valley, Joshua Tree and virtually across the state of California.

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