FAQs: Understanding Your Insurance Coverage
by Hannah Lane, Clinical Care Coordinator
If you are using your mental health benefits through your medical insurance at our office, we have compiled the following frequently asked questions to help you better understand what this means for you. We are always happy to help answer any questions you may have about your coverage at our office, although we also encourage you to reach out to your insurance company in order to receive the most accurate and up to date information about your policy and its coverage.
Will insurance cover my services at your office?
Your coverage will depend on a few different factors:
- your specific insurance plan
- the services you are receiving
- your mental health diagnosis
To find out more about your insurance’s mental health coverage, please reach out to your insurance company directly or consult your benefits material. More information about calling your insurance company to discuss your benefits can be found here.
Your insurance will also be able to tell you what services they do and do not cover. Most insurances, including BCBS, have lists available online detailing their non-covered services.
Your mental health diagnosis will be determined during your first session at the office, and will become a part of the focus of your sessions.
What is a mental health diagnosis?
A mental health diagnosis helps determine, based on symptoms and certain criteria, a specific condition that brings you into the office for counseling. Just like you might be diagnosed with a cold or a sprained ankle when you visit your primary care doctor, your diagnosis helps determine the focus of your sessions with your provider. This diagnosis does become a part of your health record.
Why do I need a mental health diagnosis?
Your insurance company requires a mental health diagnosis in order to determine whether the services you are receiving will be covered. If your sessions are not related to a diagnosable mental health condition, your insurance will reject your insurance claim. For example, if you are coming in with your partner or spouse for couples counseling, your diagnosis might be more focused on your relationship than a diagnosable mental health condition. If this is the case, your insurance will consider your sessions a non-covered service.
Why doesn’t insurance offer coverage for couples counseling?
Insurance focuses their mental health coverage on diagnosable mental health conditions, and generally does not offer coverage for services that they consider non-medically necessary.
What happens if I don’t have a mental health diagnosis?
If you don’t have a mental health diagnosis, we will still bill your insurance for you, but we will collect payment in full at the time of service, since your insurance will most likely reject the claim for that session.
Do you have to bill my insurance?
No, you may choose to opt out of using your insurance. Information about our private pay bundle package can be found here.
If you have additional questions about your mental health diagnosis, talk to your counselor. If you have additional questions about your insurance coverage, please contact Hannah at 319.250.1267 and she will be happy to assist you.