Focus Forward Counseling and Consulting, Inc. accepts virtually all major insurance plans. If your insurance doesn’t cover the requested service or if you choose not to utilize your insurance we offer affordable rates to make counseling, therapy, and psychological evaluations accessible.
Should I use insurance? Will my confidentiality be protected?
There are costs and benefits of using mental health insurance. The main benefit is that it can be helpful at times in terms of limiting your out of pocket expenses. There are also significant limitations to be mindful of. One is that your mental health diagnosis will be saved in your insurance records and it is difficult to predict how this will affect your future insurability and premium costs. In addition, your privacy is limited as insurance companies have the right to review your clinical records if they choose to. Some individuals prefer that this information be kept completely confidential between client and therapist. If you would like to learn more about fee for service options, click here.
Verification of Benefits
Mental health insurance policies can be challenging to understand. At Focus Forward we’re happy to help you sort through the information and will contact your insurance provider on your behalf to verify your insurance coverage. In the meantime, the following information lists some frequently asked questions related to mental health coverage.
In a typical mental health plan, how many visits are covered?
Mental health plans can vary dramatically. Most plans allow unlimited visits without the need for authorization for routine outpatient services; psychological testing typically requires preauthorization. Employee assistance program (EAP) plans usually offer three to six sessions.
What will my plan cover?
Most insurance companies reimburse based on medical necessity; this means that they will cover mental illnesses but they tend to have more restrictive coverage options for everyday problems of living such as grief and loss, couples and marriage counseling, career counseling, and general relationship matters. In other words, this can be a good news/bad news situation in which healthy individuals (the good news) with important concerns get denied coverage (bad news) due to not being mentally ill.
Can I see a therapist of my choosing?
If you have a Health Maintenance Organization (HMO) plan or a prepaid health plan, you may choose from a limited pool of health care professionals. These professionals are in-network providers, and it may not be possible to see a therapist of your choice. With a Point of Service (POS) plan (also known as a Fee for Service plan), you can see any doctor in the country, and your insurance company will assist in the coverage of your fees. Preferred Provider Organization (PPO) plans tend to be the most flexible, allowing you to meet with both in and out of network providers. For a full description of these plans, see the glossary below.
Will I need a referral from my primary care physician?
Typically no, but because some insurance companies do require a referral from a primary care physician be sure to inquire before you start your search for a therapist.
What is an Employee Assistance Program, and how can I use one?
Some employers set up company Employee Assistance Programs (EAP) that help workers identify and resolve personal problems, emotional struggles, family difficulties or legal problems. They are often free, but limited in number of sessions. Check with your employer to see if these services are offered.
Glossary of Plans
Deductible plans: These plans are similar to traditional health care plans, in which insurance companies pay for the services you receive as a policyholder. You pay a premium—a monthly fee—and in turn you may choose any doctor you wish and visit any hospital for services. The deductible is a certain amount of money that you must spend on health care each year before the insurance kicks in. After you have spent that amount, you share payments with your insurance company based on a percentage (for example, you pay 20 percent of the session fee and the insurer pays 80 percent). While the up front cost can appear intimidating at times, many of these plans are actually quite reasonable with extended care.
HMO: Health maintenance organizations contribute to the cost of mental health care. Your choice of health care providers and facilities is limited. This group of professionals is called a network. In an HMO, you may be assigned a primary care physician, who will refer you to specialists in the network. You will be required to pay a co-payment for each visit.
POS: Point-of-service is an HMO-based plan that also allows for out-of-network visits. To use in-network providers you must have a primary care physician. A POS plan is a regional plan. Members can use services outside the HMO area, but they must reside inside the HMO area to be eligible for coverage.
PPO: A preferred provider organization combines a fee-for-service plan with an HMO. The result is national insurance coverage in which you may choose from providers on a “preferred” list and pay lower costs. You are also typically able to meet with non-network providers.