TIPS ON TALKING TO HEALTH INSURANCE COMPANIES About Mental Health Benefits

Most health insurance policies have some form of mental health benefits. The following information is a guide to inquiring about your benefits and making claims for counseling expense reimbursement.

It is important to know the following about your counselor, Trudy Colflesh: She is a Licensed Professional Counselor (L.P.C.) in the States of Colorado and New Jersey with a Masters degree (M.A.) in counseling. In most cases, she is a non-participating mental health provider, also called an Out of Network counselor.

The insurance member (you) pay the full counseling fee of $100 by cash or check directly to Trudy at the end of each 50 minute counseling session. At the end of every month Trudy provides each client with a statement that can be submitted to the mental health insurance company. You will then be sent direct reimbursement of your policy's percent of reimbursement paid for that month's sessions. For example, if your policy offers a 70/30 percent reimbursement, you will receive $70 back for each session up to the allowed amount of sessions per year. Your deductible will be taken out first, (usually required for Out of Network providers), if your deductible is $300, you will meet it in the first three sessions. Making insurance claims may seem complicated, but once the first claims are made the system should work smoothly.

The starting point is to call the insurance company using the phone number provided on your insurance card. If there are several numbers on the card, use the one designated for mental health. Generally, the phone is answered by a computer using a menu of prompts. Find the prompt designated for "members" or "member services", which will then usually supply sub-prompts, one of which should be for mental health. If possible find a prompt that leads to a "live" (non-automated) representative.

Each company, indeed each policy, has a unique set of qualifying parameters defining the available coverage. If insurance reimbursement is expected, it is vital for the client to be assured in detail that this particular circumstance is covered. In speaking with your representative, ask these questions:

What is my mental health coverage for outpatient treatment?

Is the policy current and in good standing?

Does the policy include services provided by a Licensed Professional Counselor (L.P.C.) and/or a counselor with a Master's Degree in Counseling?

Does the policy cover "Out of Network" counselors?

	If "yes", what limitations are involved?
	Are phone sessions covered?
	If "no", ask if you can appeal to use Trudy because of… (and state your reasons.)

What deductible applies for mental health counseling if "Out of Network"? Is this an annual fee? Is there a carry-over policy on deductions if starting at the end of the year?

What percentage of the acceptable fee is reimbursable? Is this percentage limited by the diagnosis?

How many patient counseling sessions are permitted annually?

Is pre-approval required before starting counseling? If so, by whom?

Does the counselor need to submit a treatment plan? If yes, how often?

What address (or fax number) is used to submit your mental health claims? (It may be different for mental health). What form is used? Can they fax or mail the forms to you? - How rapidly is the claim paid following submission?

While it may seem "picky" to ask so many questions; knowing the answers can save much frustration and many delays in reimbursement. If you have questions of Trudy Colflesh, you may e-mail her at trudy@encouraginghope.com.

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