Will my health insurance pay for counseling with Elizabeth?
To understand if your health insurance pays for counseling, you need ask,
- Will my health insurance pay for the treatment of my particular problem?
- Will my health insurance pay for Elizabeth to be my therapist?
- Are there other options to pay for counseling?
Does my insurance cover my problem?
For people using their employee assistance plan (EAP): You are in luck! An EAP will cover almost any issue that has you seeking counseling. Check below to see if Elizabeth is in-network with your plan.
For individual clients: If your problems interfere with daily life, your insurance will usually pay for counseling. Major mental health problems such as depression or bipolar disorder are covered by all health insurance plans. Most plans also cover problems that interfere with daily life such as feeling overwhelmed or hopeless or having trouble concentrating to the point where it is hard to get things done. They will also pay for treatment if you are experiencing anger, worry or grief that seem out of proportion to the triggering event.
However, sometimes people need to make changes but it is not causing enough distress to be covered under their insurance plan. In these cases, counseling is still fully justified but the insurance company won't pay for it.
Figuring out if your situation meets the criteria for a specific diagnosis is the job of a licensed therapist. However, you should be prepared to talk with your therapist about whether your situation falls within a covered diagnosis.
Just because insurance doesn't pay for counseling, doesn't mean that you don't have a problem that deserves professional help. Read below for some other ways to help paying for counseling services that you need.
For couples: My approach to couples counseling focuses on the relationship. I bill using a diagnosis of "partner relational problems" (Z63.0). In addition, you need coverage that includes family sessions, CPT procedure code of 90847. So your insurance only pays if your plan covers both the diagnosis and the procedure. To find out if your insurance covers couples counseling, call and ask (1) "Do I have coverage for a diagnosis of Z63.0?" and (2) "Am I covered for the procedure code 90847?" Don't ask, "Do you cover couple's counseling?" since you need to know more precisely what kind of coverage applies.
If you are not covered by either category, read below for ideas on how to get help paying for the counseling services that you need.
For individual clients: If your problems interfere with daily life, your insurance will usually pay for counseling. Major mental health problems such as depression or bipolar disorder are covered by all health insurance plans. Most plans also cover problems that interfere with daily life such as feeling overwhelmed or hopeless or having trouble concentrating to the point where it is hard to get things done. They will also pay for treatment if you are experiencing anger, worry or grief that seem out of proportion to the triggering event.
However, sometimes people need to make changes but it is not causing enough distress to be covered under their insurance plan. In these cases, counseling is still fully justified but the insurance company won't pay for it.
Figuring out if your situation meets the criteria for a specific diagnosis is the job of a licensed therapist. However, you should be prepared to talk with your therapist about whether your situation falls within a covered diagnosis.
Just because insurance doesn't pay for counseling, doesn't mean that you don't have a problem that deserves professional help. Read below for some other ways to help paying for counseling services that you need.
For couples: My approach to couples counseling focuses on the relationship. I bill using a diagnosis of "partner relational problems" (Z63.0). In addition, you need coverage that includes family sessions, CPT procedure code of 90847. So your insurance only pays if your plan covers both the diagnosis and the procedure. To find out if your insurance covers couples counseling, call and ask (1) "Do I have coverage for a diagnosis of Z63.0?" and (2) "Am I covered for the procedure code 90847?" Don't ask, "Do you cover couple's counseling?" since you need to know more precisely what kind of coverage applies.
If you are not covered by either category, read below for ideas on how to get help paying for the counseling services that you need.
If my problem is covered, will my insurance pay Elizabeth to be my therapist?
In-network coverage: Most insurance plans charge you less if you use providers in their network. Elizabeth is a provider in most of the networks offered by the companies below. Since each network has many sub-networks, the only way to know for sure is to look her up in the directory for your specific plan.
Anthem/Blue Cross
BeaconOptions
Lyra (EAP)
BeaconOptions
Lyra (EAP)
Out-of-network coverage: If you have a preferred provider (PPO) plan with out of network coverage, your insurance also pays if you receive services from someone not in your network. If your insurance is not on the list above but you have out-of-network coverage you are in luck. You pay Elizabeth her full fee and your insurance company will reimburse you for much of the cost. Call your plan and ask how much they pay for out-of-network mental health services. (Typically, plans pay from 50% to 90% of the fee.) Also ask about deductibles, since sometimes there is a separate deductible for out-of-network expenses.
Other Possibilities for Paying for Counseling
Health Saving Accounts (HSA) & Flexible Spending Accounts (FSA): These accounts allow you to set money aside tax-free to use for medical expenses. In most cases, these funds can be used to pay for counseling although the final decision is made by your plan administrator. If you have a credit card linked to your HSA or FSA, Elizabeth can charge your account directly. If not, she will provide you a statement that you can submit for reimbursement.
Employee Assistance Plan: Elizabeth works with Employee Assistance Plans (EAP) from Lyra The EAP program gives you a limited number of counseling sessions, for most problems, at no cost to you. For simple issues, that may be enough to help you get your balance back. For more complex issues, it will give you a better understanding of the problem and a road map for how to move to forward.
Employee Assistance Plan: Elizabeth works with Employee Assistance Plans (EAP) from Lyra The EAP program gives you a limited number of counseling sessions, for most problems, at no cost to you. For simple issues, that may be enough to help you get your balance back. For more complex issues, it will give you a better understanding of the problem and a road map for how to move to forward.