Great question!!
The answer is: it depends!
Quite a few private health insurance companies cover psychotherapy and psychological services, and plans and coverage vary from company to company. Most insurance companies are understandably cautious about telling health care providers about what types of coverage or amounts of coverage are available for each insured person.
Trust me - our office has tried to look into these sorts of things for our clients, many of whom find this stuff confusing or overwhelming, but in the end the insurance companies will not tell us anything about your coverage. Not a thing!! This is a special privilege offered to dentists and pharmacies, but not to mental health care providers. BAH! So sorry!
Given that even with your written consent, the insurance companies will still not share information about your coverage with us, how do you find out if you have any funds to use to help offset the costs of private therapy? Before attending your first appointment, it is recommended that you check with your plan administrator to ensure that you know what coverage you have, and if you require a physician’s referral pre-dating your first psychology appointment in order to be reimbursed for fees.
Get ready to make a few notes here. Look at your insurance card for the number for the insurance company, call in to ask the following questions exactly, and write down the info before you call us, so that we can help you with your options:
“Does my plan cover psychotherapy services when offered by a licensed, Registered Psychotherapist?”
“Does my plan cover psychotherapy services when offered by a licensed, Registered Psychotherapist?”
“Does my plan cover psychotherapy services offered by a Registered Psychotherapist if this person is supervised by a licensed Psychologist and the psychologist’s name appears on my session receipt?”
“Is there a copay for each appointment, a minimum spend or deductible before I can claim the treatment fees, or a percentage that I am reimbursed per appointment? Is there an hourly maximum for each type of therapy provider, Psychotherapist, or Psychologist?”
“What is the maximum dollar amount I can claim for psychotherapy services each year?”
“What is the rollover or renewal date for my coverage? Is it the beginning of the calendar year?”
“Do I need a doctor’s note in order for my fees to be reimbursed by your company?”
Psychotherapist vs. Psychologist
It is helpful to know if your plan has restrictions on the type of therapist that you are eligible to receive funds to work with. If there are special requirements here, it will help you understand which type of professional to plan to work with.
Supervised vs. Not Supervised
This kind of sounds iffy, but rest assured that all services provided at Limestone Clinic are subject to quality assurance reviews, audits, and oversight by clinic administration and senior clinicians; however, sometimes within the clinic some staff are working under the supervision of a Psychologist and this may mean that services that might not otherwise be eligible for reimbursement are now services that are eligible because the Psychologist is taking responsibility for the work. If you learn that a Psychologist is covered but a Registered Psychotherapist is not, this may be a way that you can find covered services.
Copay, Minimum Spend or Deductible, Percent Coverage, and Hourly Maximum
A copay is an amount that you must pay for your services, regardless of what the service fee is. For example, some insurance companies will state that clients must pay $25 per session, regardless of the session fee or duration, and the remainder of the fee is covered by the insurance company.
Minimum spend or deductible describes how much you have to pay for services rendered, after which your insurance will fully cover or cover a portion of your services. For example. some companies require that you provide evidence that you paid for the first $500 of services before you can apply for any additional funds paid to be reimbursed.
Percent Coverage means that when you get a reimbursement, it is for a percentage of the funds you paid for your therapy. For example, if your percent is 80%, for every $100 you spend, the insurance company will reimburse you $80.
Hourly Maximum billable amount means that this is the most an insurance company will consider able to be reimbursed and has an upper limit. For instance, at the time this article is written, many claimants who are covered by Blue Cross/Medavie are eligible for a maximum hourly spend of $195 for Registered Psychotherapists. This means that the first $195 charged of every billed psychotherapy hour will be eligible for coverage (assuming funds are available). If the fees you were charged were $200 per hour, the additional $5 would be paid by you and not eligible for consideration by your insurance company.
Yearly Maximums, Rollover Dates, or Renewals
Most insurance companies have maximum dollar amounts you are eligible to receive refunds for when you see a Psychotherapist or Psychologist. Some of them are amazing - shout-out to Starbucks, with limits of $10,000+ per employee, per year - and some are only enough to just get started before coverage runs out. It is good to know if you are in the $10,000 per year, or the $250 per year category, to assist you in finding the therapy option that will best fit your budget and your anticipated need. If you only plan to come in once, the $250 plan isn’t a barrier, but if you think you will need 10+ sessions of therapy, this plan will need some source of additional funds for private care such as that offered by Limestone Clinic in Kingston, will be a good match for you.
Additionally, knowing what time of year the plans renew can be an important consideration for treatment planning. Many people enjoy feeling like they can “double dip” over the months before and after yearly renewal, and enjoy planning to come in for therapy at a time when they will be able to attend funded therapy for twice as long as if the therapy occurred in the middle of the insurance company’s year. For example, if your plan offers you $1,000 in funded care in 2021, and $1000 of funded care in 2022, you may feel inclined to arrange to start your therapy in November of 2021, so that you have the option to continue therapy with the new funding that becomes available in January if the company’s rollover date is January 1st of the New Year. Sometimes extra information about these factors can feel helpful in planning for the financial aspects of your psychotherapy care.
Doctor’s Referrals/Prescriptions for Therapy
Great question! See our link HERE for more information about whether or not MDs need to provide you with prescriptions for care before you can come see us.
Understanding your Insurance before your Free Consultation
Figuring out the ups and downs of your insurance coverage and what, specifically, is available for you to claim with your particular extended health benefits plan is a bit of a pain in the butt, but it will be helpful for you to know your financial needs before arranging for private care. I hope that this information has been useful to you and has helped you understand some of the information you may want to take into consideration when you are planning for your care with us at Limestone Clinic.
Rest assured, we are interested to welcome you into the fold, dive into work, and to collaboratively transform your emotional life as quickly and efficiently as possible. We would be honoured to explore if working together would be a good fit. Please call our office at 613-877-4148, or email us at hello@limestone.clinic, to book your free consultation today.