The Shrink’s Links: NYS Department of Health, Bureau of Managed Care Division

Bringing you the best of mental health every week.

Having no health insurance can kill you, but having insurance can frustrate you half to death.

Many of the calls I get from prospective clients are people with insurance, but, for whatever reason, their insurance will not cover them to see me. Every other therapist I know finds the same thing. It has nothing to do with qualifications, skills, or experience.
It’s the game insurance companies play to keep you from spending their money.

Blue Cross/ Blue Shield/ Excellus may be the worse offender. They have the largest market share in the Rochester area and allow the smallest number of mental health providers into their network. Just try getting the help you need when you have that insurance.

Twenty-seven states don’t have this kind of problem. They have “Any Willing Provider” Laws that allow members to chose any mental health provider, rather than only the ones on their insurance company’s list. “Any Willing Provider” was written nationally into law under Obamacare, but in language that is impossible to enforce. The result is that, in New York State, you do not have the freedom to chose your provider. The result is that mental heath care is often inaccessible.

In this week’s shrink’s links I have for you the webpage of the New York State Department of Health, Bureau of Managed Care Division; just the place you would want to contact if you have a grievance against your insurance company. I’ve filed two complaints last year, winning both, regarding insurance companies that failed to honor their contracts.

Click here to go to the page.

You can also call 800-206-8125

“Do you take my insurance?”

This is the most frequently asked question when people make their first phone call to set up an appointment to see me for counseling. It seems like a simple question, but it’s not.

When you ask if I “take” your insurance, I suspect you’re asking whether I am a member of your insurance company’s network of providers. Membership has its advantages to you. If I am, as they say, “in network”, then, except for your copay and deductible, I can bill them directly and you don’t have to deal with the rigmarole of submitting claims.

I’ve applied to be “in network” for every insurance network I ever heard of. They all ask the same questions about my qualifications. Most of them have told me that they have enough providers already, but they’ll keep my application on file.

The real issue is not whether I “take” your insurance; the issue is whether your insurance “takes” me.

Despite having been turned away by so many because they think there are enough counselors, I am currently in the networks of Excellus, Blue Cross/Blue Shield, Value Options, Beacon, MVP, Emblem Health, and GHI. I usually can “take” those insurances.

Usually?

It gets complicated.

Gone are the days when you could say the name of your insurance company, and a counselor could tell you if he or she “takes” that insurance.

Many insurance companies these days contract with other companies to administer the mental health portion of their policies. Some of them contract with more than one other company. In order to answer your question, I need to know which company your insurance company contracted with for your particular plan.

It might say on your card; might.

Value Options is one of those companies that contract with other companies to administer the mental health portion of their policies. If you have Blue Cross/Blue Shield, MVP, or a host of others, your plan might actually be covered by Value Options. If that’s the case, then, hurray, I’m “in network” for you. However, some Blue Cross/Blue Shield and MVP plans are associated with other companies.

Oy, gevalt.

If you call me, the only thing I can do is look it up to tell you. I’ll need your name, ID number, and date of birth.

If I’m “out of network”, the insurance company may be willing to reimburse you for some portion of our sessions, but you would pay a larger portion of my bill than you would if you saw someone “in network”. You would have to submit a claim to them after paying me. Their willingness to pay anything depends on the individual plan that your employer selected. You can call them up and ask if you reach a real person.

A good portion of the people who call me decide that they will see me anyway on a self-pay basis. I charge $95 a session. Maybe they just want to get on with counseling. Maybe they’re just grateful that I, a human being, answered the phone. Maybe driving their customers to self-pay is what the insurance company is hoping for when they make it so difficult to access care.

Here’s another thing that determines whether I “take” your insurance. You have to have an approved, diagnosable mental health condition for insurance to pay and I have to tell them what it is.

Many people call a counselor for problems that have nothing to do with a bona fide mental health condition. They have marital problems, or are thinking about a career change, or they have anger management problems that may or may not be associated with anything diagnosable. If that is the case, then I can definitely help you, but you’re out of luck when it comes to your insurance paying for it, whether I am “in network” or not.

There are definite advantages to NOT using insurance to pay for counseling. I’ve had some people elect to pay for it themselves, even though I do “take” their insurance. They’d rather no one know they’re seeing a counselor; they don’t want the insurance company dictating their care; or they don’t want their trouble cast in terms of a mental health problem. These can be excellent reasons to self-pay.

In summary, the devil is in the details. Sometimes, little words, innocently used, obscure a whole platoon of devils. Just that little word, “take”, hides the mess insurance companies make. Call me and we can figure it out, together.