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1. Giving misleading information about the full amount of coverage you have & which providers are covered
2. Requiring you to tell several gatekeepers your story
3. Not helping you find an African American or other specialized therapist
4. Having a non-professional ask for very personal information
5. Not paying claims accurately or quickly
6. Using words like "mentally ill, mental disorders" etc. rather than "behavioral care" when discussing your problem

You can determine your coverage more accurately by asking the insurance claims person these specific questions:

1. Is preauthorization required in order for me to be reimbursed for psychotherapy services?

2. Will my policy cover the services of licensed providers outside of my plan?
    If not, how will the policy provide for me to see a black therapist? If not, you might contact the provider services manager to request a black therapist.
    If so, and there is a co-pay difference, what is the monetary difference? (One insurance provider warned ominously of a higher cost if their contracted provider wasn't used. After contacting the provider the client found out that there was only a $10 difference in the cost per session and the deductible had already been satisfied in medical services the client had used earlier in the year.

3. Is there a limit on the number of sessions covered by my policy? How long a session does the policy cover? Some states mandated the equivalent of 50 sessions a year. Some insurance companies reported this as a 20 session a year benefit but didn't mention that they cover up to 180 minutes per session rather than the standard 50 minute session. They could claim they offered the coverage but the provider & client didn't use it. It's that dicey now.

4. If you are told less than 50 sessions a year are covered, ask if that's just for certain diagnoses?

If your insurance coverage doesn't sound adequate:

1. You can compare the answers of your state insurance commission (call your local 411 or your state capital)  to those of your insurance company to find out:

• What mental health benefits are mandated by your state
• How many sessions you are entitled to
• What percentage of the fee your insurance company must pay
• How your deductible should be calculated - Will a number of your sessions be taken out of your deductible?
• How you can get your insurance company to pay for the services of the provider of your choice
• Remember that companies will err on their side if you'll allow it

2. You can ask about the limits of coverage from your company benefits representative if you feel they will keep your inquiry confidential.

3. You can ask your therapist to call and determine your benefits

However, it is not a level playing field now. Insurance companies are hard pressed to save money and they are utilizing a number of "borderline" techniques to confuse you about your benefits. If they give you questionable information, ask them to put it in writing. If they say your state only mandates partial benefits, ask them to send or fax you a copy of the law which says that. If they change their mind at that point and "discover" their error in reading you your benefits, write down the name of the person you're speaking to and note the date & time.  Back to top

For example, Virginia clients were reporting that their insurance companies, as of last June, were telling them that they were covered only for 20 therapy sessions a year. A law, however, was passed requiring insurors in Virginia to cover a full year of weekly sessions. When contacted and challenged, several insurance companies said, "A client is covered only for 20 sessions a year, UNLESS their reason for seeking therapy can be shown to have a biological or organic basis - then they are covered for 100% of unlimited sessions, as they would be for any other medical visits." What percentage of therapy issues are biologically based? Probably 80%!

So don't be shy or intimidated (but be nice-they can jam up your claims) in asking the insurance claims people to explain the details of your benefits. They are often instructed in ways to reduce claims. The insurance companies are not saviours. They are financial institutions that are betting that you will pay in more money in premiums than they have to pay out in claims. We are hearing about some very misleading methods being used to reduce your benefits.

4. Keep good records
Keep a copy of each statement & claim mailed. Keep notes on the date, time, claims person's name and content of each conversation you have with the insurance company

5. Check your "Explanation of Benefits" statement that comes with your claim payment carefully. Did they pay for all the dates of service? Did they take out a deductible more than once in the calendar year? Did they take out a deductible twice on one line: first by deducting it from the total fee and again by deducting it from the "amount your insurance covers"? If you don't understand it, take it in to your therapist to look it over with you.

6. Use your intuition. If the coverage you're offered doesn't sound like the way an insurance company would cover treatment of diabetes or a broken leg, seek information from sources outside the insurance company.             

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Check your state mandates

Ask for a copy of the law that mandates your benefits

Examine your claims payment closely

Insist on the kind of provider you need

Give limited personal information, i.e "I have a family issue" or "I've had mood changes"

Keep records of every contact with the insuror

Use your intuition - If it doesn't sound right, it probably isn't correct

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