Insurance Tidbits

If you’re changing jobs or you’re preparing for open enrollment, it’s important to be mindful of your choices and how they impact mental health care. Keep in mind that I am not a financial advisor and do not sell or handle insurance in an official capacity beyond my own benefits and billing on behalf of my clients. If you have nitty-gritty questions, please defer to your insurance company’s member services line or your benefits coordinator at work.

Parity

In Colorado, all medical health insurance plans need to cover mental health treatment at the same level they would cover a “physical illness.” (This is not 100% airtight. As of now, a plan that is not offered on the marketplace—aka Connect for Health Colorado—might not offer behavioral health benefits and might choose not to cover certain conditions that were not originally covered in the state’s own parity law. One common example of something that isn’t required to be covered is substance abuse.)

Telehealth

In Colorado, insurers are supposed to offer the same coverage for mental health services rendered via telehealth (phone or video) as they would for in-person services.

Deductibles, Co-Payments, and Co-Insurance

Most insurance plans have deductibles. If you have out-of-network coverage, you probably have a higher deductible for out of network than for in network. If you are on a family plan, you probably have an individual deductible and a family deductible.

Again, this is where exchange plans and other health insurance plans can be different. Exchange plans must cover preventative care at 100% and cannot require the deductible to be met. So if you receive an annual physical exam with your primary care doctor, that should be free to you. However, some plans may be exempt from this and if you are treated for a condition, your deductible will most likely apply.

For example, if you have a $500 deductible and my contracted rate with your insurance company is $75 for a regular session, you would need to pay that $75 until you’ve paid $500 for your own care out of pocket. Usually, insurers will calculate that based on a combination of what you pay for prescriptions, etc. Keep in mind that this still saves you money. My cash rate is $140. Most therapists in Denver charge around that amount per hour. However, if you use an in-network therapist, you will only pay up to the negotiated rate. Unfortunately, since this is all contractual, yes, your therapist has to collect that agreed-upon amount from you because we have a contract with your insurer that requires us to do so. If we don’t, that’s fraud.

Health insurance is designed to help protect you against catastrophic financial loss. It does not mean you receive all of your healthcare for free.

High Deductible Plans

In general, these are not financially ideal for anyone who earns less than six figures. However, if you are self-employed or in a two-earner household, it’s easy to hit that number and still feel pretty broke, so these are more popular than a lot of people would assume.

If you have an HSA or FSA compatible high deductible plan, you can have a Health Savings Account (HSA) or Flexible Spending Account (FSA.) Oddly enough, these days, HSAs are more flexible than FSAs because they are easier to take with you if you change employers and the money remains yours even after the tax year is over. Most of these accounts provide the option of having a debit card linked to the account that you can use to pay your therapist, pharmacist, etc. That means you don’t need to go through the drama of uploading receipts and waiting to be reimbursed, and the money you put into those accounts isn’t taxed. So it is more than a glorified savings account.

The major downside of high deductible plans is you could be looking at a deductible of $7,500 or more. However, you still benefit from your insurance company’s negotiated rates, and, if you have a really bad year health-wise and do end up meeting your deductible, that typically means you do not need to pay copays or coinsurance after that.

Therapy When You Can’t Even Pay the Co-Pay

If you are not self-employed, ask your benefits office if they offer an EAP. Most employers do. EAPs (employee assistance programs) typically offer a certain number of sessions per year to each employee each year. Sometimes, you can even receive authorization for additional sessions. This is a terrific low-investment way to get some support when you need it.

Another option is Open Path Collective. I will note though that Open Path Collective is not free. It’s low cost.

I also offer sliding scale appointments with an intern when I have someone available.

Budget for Healthcare

Do not give in to the temptation to go without insurance. I am not in cahoots with the insurance companies and anyone who decides they can’t afford a premium plus what it would cost to see me is welcome to their feelings, but I am invested in people staying alive and avoiding bankruptcy. Surprisingly, if you end up in the ER for something common like kidney stones, appendicitis, or even a severe case of the flu, that stay can easily top $7k. If this has already happened to you, please contact the hospital’s billing department regarding options because you can probably work something out, but it’s not ideal and it’s still going to be expensive. It’s just not worth it.

I know it’s not what anyone wants to hear, but in general, budget about $300 a month for healthcare. Some plan premiums are even less than that, but if you have a lower premium, you probably need to pick up more of the costs.