Consejos para que su seguro pague la terapia
Let’s get it done. And by “it'“ we mean breaking down barriers to affordable therapy
Vamos a decirlo en voz alta. Navegar por el seguro médico puede ser una pesadilla. Muchas personas evitan en la medida de lo posible ocuparse de los seguros porque pueden resultar muy confusos. Pero, como estás pagando mucho por esa póliza de seguro, más vale que la utilices en tu beneficio.
More and more people are using insurance to pay for their mental health treatment. At Shift Counseling, PC, we think this improved access is a very good thing! If you’re struggling with depression, anxiety, trauma, or stress related issues, help is available.
Your best bet for affordable mental health treatment: Finding an in-network provider
Even if your policy provides coverage for mental health services, finding a provider and understanding your benefits can still feel overwhelming. The most direct way to get the information you need to move forward is to call your insurance company. Somewhere on your insurance card, there should be a “customer service” number, that you can call. Yes, you may sit on hold for a while, but someone from the insurance company should be able to provide you with a list of in network providers and explain what your out of pocket costs will be.
There are some great therapist finding websites, such as Therapy search, Psychology Today, Mental Health Match, Latinx Therapy (as well as others) that can help you narrow your search by location, issues, and insurance type.
¿Con qué tipos de seguros está en red Shift Counseling, PC?
Shift Counseling, PC is in network with BCBS PPO, Blue Choice PPO, many Aetna plans, and Cigna/Evernorth.
Hot tip: You may have access to short term counseling benefits available to you through your employer, separate from your insurance plan. These are called EAP (Employee Assistance Program) benefits. You may need to reach out to your HR department to find out if your company offers an EAP program and how to get started. There is usually no out of pocket cost for members using their EAP benefits. Therapists at Shift Counseling, PC are in network with Lyra EAP.
¿Qué ocurre si tengo County Care, Medicaid, Medicare o una versión Managed Care de Medicaid?
A continuación figuran algunos enlaces a las listas de proveedores de estas pólizas:
BCBS Illinois Community Health Plans
Aetna Better Health of Illinois
What if I have “Obamacare” or an ACA policy that I bought through the exhange?
Buenas noticias: La lista de proveedores de la red para las pólizas ACA es prácticamente la misma que la de una póliza comercial normal (una póliza que obtiene a través de su empresa).
Hot tip: one affordable BCBS option on the marketplace is MyBluePlus. With this network, you do need to select a primary care provider and get referrals for specialists, but Shift Counseling, PC is an in-network provider with this plan.
We’re helping to solve the mystery of affordable counseling
¿Cuál es la diferencia entre una HMO y una PPO?
If you have an HMO policy, you will probably have to get a referral from your Primary Care Provider to see any specialist, including a therapist. They will refer you to a therapist who is in network with your HMO. This can be daunting, but it is the most affordable way to get mental health treatment if you have an HMO. Some HMOs provide out of network benefits, but we are seeing this less frequently lately. There seems to be a squeeze on out of network benefits, which sometimes leads to difficulty finding a mental health provider and long wait times if you have an HMO.
Si usted tiene una póliza PPO, por lo general no es necesario obtener una remisión para los servicios de salud mental ambulatorios de rutina (como la terapia individual semanal.) A menudo hay más proveedores que están en la red con las pólizas PPO también. Estamos observando una tendencia a cubrir la terapia ambulatoria como una "visita al consultorio", por lo que no es necesario abonar la franquicia para que el seguro comience a pagar los servicios. En su lugar, suele haber un copago razonable por cada sesión. Desgraciadamente, las prestaciones varían EN GRAN MEDIDA entre las distintas pólizas, por lo que, en caso de duda, llame directamente a su seguro para obtener la información más precisa.
Shift Counseling PC is in network with BCBS PPO, Blue Choice PPO, Aetna PPOs, and Cigna/Evernorth PPOs. We do not participate in any HMO networks.
Consejo importante: si cree que usted o alguien de su familia va a necesitar tratamiento de salud mental el año que viene, considere la posibilidad de elegir un plan PPO en su próxima inscripción abierta o acontecimiento vital calificado. Sí, los planes PPO tienen una prima más alta, pero pueden ahorrarle tiempo, estrés y dinero a largo plazo si necesita servicios de salud mental.
¿Qué es la afiliación abierta? ¿Periodo de inscripción especial? ¿Calificación de un acontecimiento vital?
Open Enrollment is when you pick your health insurance plans for the upcoming year (this usually occurs during the Fall.) A Special Enrollment Period is a time outside of the normal window of Open Enrollment when you can sign up for health insurance. A Qualifying Life Event is a change in your personal circumstances that would make you eligible to change your coverage outside of the Open Enrollment period. Hot Tip: Check out the list of Qualifying Life Events if you are stuck with an insurance policy that is not working for you. You may be able to make a change in your coverage mid-year.
We are here to lend a helping hand to those searching for affordable counseling
I found an in-network therapist, but I still don’t think I can afford long term therapy. What should I do?
Even with insurance coverage, depending on your co-pays or co-insurance, sometimes therapy is not truly affordable. If this is the case for you, tell your therapist at the beginning of treatment. We get it! If paying for therapy is causing you major stress, we can try to help you work as efficiently as possible. We can help you set short-term goals based on the number of sessions you can afford. Being this direct might feel weird, but as therapists, we are all for clear communication about boundaries and needs. Managing expectations from the beginning can help you have a positive therapy experience, and that is what we want for all of our clients.
Ok, I have been searching for an in-network therapist and I can’t find anyone who takes my insurance. Help!
Unfortunately we have gotten a lot of calls lately from people who have been searching for an in-network therapist for months. These types of stories are so sad to hear. Here are my top tips for people in this situation:
1: Contact your insurer directly. They have a responsibility to help you out in these types of situations. No one should have to wait months for mental health services. This can be dangerous, and causes unnecessary suffering. Your insurer has an obligation to maintain a robust network of providers who can meet the needs of their members. When an insurer fails to have enough providers, it is called “network insufficiency.”
2: If there is network insufficiency, you can request a “Gap Exception.” This would mean that you can request for an out of network provider be covered as in-network due to lack of in-network providers for a necessary service.
3: If you still can’t get help, see if you are eligible for a Qualifying Life Event to get you out of that policy that is not working for you.
4: En su próxima Afiliación Abierta, elija una aseguradora mejor o un plan PPO, si es posible.
5: Si sigues sin encontrar un terapeuta de la red y no puedes permitirte pagar el precio completo de tu bolsillo, consulta Open Path Collective, una organización sin ánimo de lucro dedicada a ayudar a las personas a encontrar una cobertura de salud mental asequible. https://openpathcollective.org
Hot tip: Get an FSA/HSA/HRA account and put money into it to cover out of network therapy if you haven’t been able to find a therapist who takes your insurance.
In the past few years, certain insurance companies (we won’t name names, but they are payers we don’t work with) have been making access to mental health treatment harder by maintaining low reimbursement rates for providers and escalating “administrative harassment"- meaning excessive reviews, requests for more information, and denying claims. As a result of this harassment, many therapists have stopped working with these payers as a means of protecting themselves. If your insurance company is one of these payers, you may have a very hard time finding an in-network therapist.
But, there is a workaround, and that is your FSA/HSA/HRA card. You can use your funds to pay for out of network treatment. Your therapist can give you a “superbill” so to prove that the services are legitimate FSA charge. Most therapists want to make therapy affordable, but we shouldn’t have to be the ones to sacrifice our financial health and sanity to make it happen. We have to take care of ourselves to be able to take care of our clients!
We have therapists who accept insurance and have openings for new clients!
At Shift Counseling, PC, we have therapists who have openings, even for Evenings and Weekends! We do accept some insurance plans and we can help you understand your benefits. Our therapists specialize in providing individual counseling for teens and adults suffering from depression, anxiety, trauma, and stress related issues. Several of our therapists are bilingual (English/Spanish) and are trained in CBT, EMDR, and PolyVagal therapy. Use the link above to view our therapist’s openings and see if we have appointments available that work with your schedule!
