Understanding health insurance benefits and mental health care

Health insurance benefits can be confusing sometimes, making it difficult for you to know exactly what you will end up paying for your mental health care if you choose to use your health insurance. Here’s a few things you need to know if you plan to use your health insurance to pay for therapy.

Mental Health Parity: Health insurance companies must provide equal medical and mental health benefits under the The Mental Health Parity Act of 1996 (MHPA). This act requires that large group health plans cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical/surgical benefits. There are some exceptions to this, notated here:

In-Network (INN) or Out-of-Network (OON): Every insurance company has a process by which therapists apply to become “empaneled”, meaning that they accept the health plan’s pre-determined payment rates and the members of that insurance plan will be able to use their health care plan benefits to pay for therapy from that therapist. Therapists choose which insurance companies to “go In-Network with”, apply for the panel, and then insurance companies either accept, or reject, the therapist’s application. Some therapists choose to remain Out-of-Network for most or all insurance plans. Some therapists are INN with some insurance plans, and OON with others.

  • In-Network therapists are required to accept the terms of your health plan per their contract with your insurance company. Your insurance company determines the rates that they will pay a therapist, and the therapist takes that rate, regardless of whether their actual rates are higher than the insurance has in their contract. INN therapists may not engage in what is called “Balance Billing”. INN therapists have access to information about your deductible, copayment or coinsurance, and limitations of your plan are, and they will charge you accordingly.
  • Out-of-Network therapists are not required to accept the terms of your health plan. They set their own rates, and will charge you accordingly. Some OON therapists are willing to provide what is called a “Superbill”. When you ask for and receive a superbill, you pay the therapist out of pocket for the full amount, and then you submit your superbill to your insurance plan and apply for reimbursement. You may or may not have “Out of Network Benefits” and you should contact your health insurance plan before you plan to pay for therapy in this way to confirm this, otherwise, you may be fully financially responsible for the charges with no chance of reimbursement.

Understanding Cost-Sharing: Cost-sharing is the amount you will pay out of pocket for your medical and mental health care, as defined by your health care plan. There are several types of cost-sharing, including:

  • Deductible: This is the fixed dollar amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you will pay your therapist (or other provider) $2,000 directly before your insurance company begins to pay your therapist. You don’t pay your therapist $2,000 in one large lump sum; instead, you pay their full rate out of pocket until the total reaches $2,000. Some health insurance plans include separate deductibles for medical and mental health services.
  • Copayment: This is the fixed dollar amount you pay for a single covered health care service after your deductible has been met. With a $2,000 deductible and a $20 copayment, for example, after you pay down the deductible, you pay your therapist $20 per week directly, and your insurance plan pays your therapist the rest of their contracted rate.
  • Coinsurance: This is the fixed percentage that you pay of a single covered health care service after your deductible has been met. With a $2,000 deductible and a 10% coinsurance rate, for example, after you pay down the deductible, you pay your therapist 10% of the rate they’re contracted to receive through your health insurance plan. If, for example, you attend a 55 minute therapy session (coded as 90837), and your insurance contracts with your therapist to pay them $125 for that session, then you would pay your therapist $12.50 for each session.
  • Out of Pocket-Maximum: This is the maximum amount of money you should pay in a benefit year through your insurance plan. With a $4000 out-of-pocket maximum, and a $2000 deductible, and $20 copayments, once you’ve paid your therapist a total of $4000 after deductible and copayments, your insurance company will begin paying your therapist their full contracted rate, and you will not need to pay any more directly in that benefit year.
  • Explanation of Benefits: This is a document your insurance company will send to you to explain exactly what you owe your therapist. You should check these regularly to ensure that you are being charged correctly.
  • Explanation of Payment: This is a document your insurance company will send to your therapist to explain to them exactly what you owe them, typically 2-4 weeks after a service has occurred, but sometimes longer. Your therapist should compare what they have charged you against the Explanation of Payment that they receive, and they will adjust your statements accordingly (if, for example, they have undercharged you, or overcharged you).

The best way to know what your deductible, copayment, coinsurance, or other plan terms are is always to call your health insurance company directly and ask. You’ll need your health insurance card, and other basic identifying information as well.

Good Faith Estimate and the No Surprises Act

You have the right to receive a “good faith estimate” that explains how much your medical care and mental health care will cost. Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

I hope this brief primer has helped you to understand a little more about the world of insurance and mental health coverage. I find that it’s best for a solid therapy relationship when everyone is clear up-front about finances, rights, and responsibilities. Check out for more terms and definitions to help you understand your health insurance benefits.

How to Know When Young Children Need Therapy

This is a question that troubles a lot of parents and caregivers, so if you’re asking yourself this question, don’t worry, you’re not alone. A lot of people are surprised when I tell them that I often work with very young children. Some of the doubts people express have to do with children’s ability to hear, understand, and remember stressful events. It’s true that young children experience the world really differently from older children and adults. You might think back to your own childhood and think, “Sure, there were some hard times, but I never had to go to therapy!” These are all really valid reasons to wonder whether therapy is necessary for a young child.

I’m glad people feel skeptical about sending young children to therapy, because I don’t think it’s good for anyone to get therapy they don’t need. In fact, I think that drawing way too much attention to stress when kids are having a normal reaction to stress can make things worse! But I also know that kids give off some really subtle signs that they’re having a hard time, and that sometimes even the most well-intentioned parents and caregivers can miss those signs, and therefore miss a chance to help before the problems get worse. So I’m here to help you get a better sense of what is a normal stress response, and what are some signs that your child needs you to reach out for some professional help.

Young children face lots of stressors. Some common stressors children experience include developmental changes, like learning to crawl and walk, learning to eat solid foods, trying new foods, potty training, welcoming (or not welcoming) a new sibling, teething, family structure changes like break-ups and divorces, season and weather changes, moves, changes to the people they see regularly like a babysitter or neighbor, and many, many more. The littlest changes in routine can trigger a stress response for young children. Consider this: if something in your family life is stressful to you, it is most definitely stressful to your child, and many things that are not particularly stressful for you are stressful for your child. For young children, everything new that happens, including positive things, is stressful because it is a new thing for them to understand and master. That takes lots of mental energy and sometimes physical energy and is hard on our little ones!

Some stressors that young children experience are more serious than the ones listed above. Despite your best attempts, your child may have seen, heard, or experienced something traumatic, such as being physically abused or witnessing physical abuse, losing a parent or loved one, experiencing a serious and life-threatening illness, or one of these other adverse experiences. When this happens, it is strongly advisable for you to take your child to see a trauma-informed therapist to screen your child for symptoms of PTSD regardless of what you are seeing at home. The therapist will be able to use specialized tools and skills to determine in partnership with you whether your child needs therapy to help cope with the experience.

Most children will experience some brief regression in their skills and activities during these stressors, lasting a few weeks at most. You might notice your child sleeping or eating differently, speaking less often, playing less or differently, changes in behavior at home and/or school, appearing angry or irritable, becoming tearful often, having frequent tantrums, being aggressive, acting more impulsively than usual, having accidents, clinging to you, or otherwise behaving unusually. Here is a similar, more thorough checklist for you to consult. Your job as a parent during this time is to reassure your child as much as possible and tolerate their regression; you are their rock, and they need to know that regardless of the changes and stressors taking place in their life, you’ll be there for them.

When the changes you’ve noticed last longer than a few weeks past the change or stressor, you should begin to consider whether your child needs some additional help to cope with the stress. This is the time to contact a therapist for a screening and assessment.

In your first few visits with a therapist, they will want to collect a lot of information about you and your child. While you may be eager to jump right into therapy, it’s important that your therapist take the time to assess your child for symptoms of an emotional health need so that they can provide the kind of therapy that is right for your child, or refer you and your child to a different kind of specialist. Not all therapists treat all types of issues presenting in early childhood. Your therapist might refer you to early intervention, the public schools for testing, a developmental pediatrician, a psychological testing agency, an occupational therapist, or an ABA specialist, just to name a few! If that feels overwhelming for you, don’t worry: your therapist will be able to explain the reason for this referral.

In order for a therapist to bill your health insurance, they must diagnose your child. If you are paying for therapy out of pocket, a diagnosis is not required, but therapists are still ethically compelled to let you know if they believe your child meets criteria for a mental health diagnosis. Therapists may use multiple different tools to assess and then either diagnose your child, or refer you elsewhere if they feel that more intensive assessment is needed to produce an accurate diagnosis. A mental health diagnosis is protected health information, which means that no one needs to know except for you and your therapist (and your insurance company, for billing purposes). Many parents fear that a diagnosis will cause their child to be “labeled” in school. The truth is, a diagnosis is kept private unless you authorize it being shared outside of therapy. Your child’s school does not need to know your child’s diagnosis unless you think it will help your child access services and education more effectively.

I hope this has helped you understand the process of choosing whether and when to bring your young child to therapy, and what the beginnings of the process look like. If you are asking the question, you are already doing the right thing for your child!

Is Group Therapy Right for You?

Group therapy is a well-regarded therapy modality because life is all about relationships. Think about it: when you identify goals for therapy, they’re largely based around problems that come from your satisfaction with the relationships in your life. Am I right?

In group therapy, you interact and relate with other people, and guess what? The same patterns that show up in your personal life show up in your group therapy relationships! The difference between group therapy and real life? You have your group therapist right there to help facilitate the group interactions, highlight patterns that you might not be seeing, and subtly and gently nudge you to try a new, more satisfying way of relating to other people, and to yourself. Over time, group members take on a lot of the work of the group, sometimes helping you notice your patterns, and sometimes learning from you as you notice their patterns. It’s an incredibly healing experience to try out new ways of being in relationships in the safe cocoon of a therapeutic group.

Irvin Yalom, MD is a distinguished psychiatrist who wrote about 11 therapeutic factors of group therapy. They are:

  • Instillation of Hope: You will feel more hopeful as a result of being in a group with other people who share similar struggles, and similar successes!
  • Universality: You will begin to feel that you are not alone in your struggles; that someone else has been there before, and therefore you need not feel so isolated.
  • Imparting Information: By learning from the group therapist and from each other, you’ll walk away from group more informed about your struggles, coping mechanisms, and also about resources you can seek for help.
  • Altriusm: You will contribute something positive to other group members, like helping them feel seen, supported, cared for, and listened to, and then you will feel good yourself about having made a positive impact in someone else’s life and growth!
  • Corrective Experiences: You will likely begin to experience positive and satisfying relationships with other group members, including conflict resolution, which might be different from other relationships from your past that went poorly. As a result, this can help you feel that you have “corrected” and old negative experience by having a new positive experience, and you may begin to feel more confident having healthy conflict resolution in other relationships in your life.
  • Socializing Techniques: By participating in a regular social activity, you’ll naturally learn and develop your socializing skills such as empathy, tolerance, and other interpersonal skills.
  • Imitative Behaviors: You and other group members will subconsiously (or consciously!) observe other group members’ adaptive behaviors and coping skills, and learn to incorporate some of those skills into your own toolbox.
  • Interpersonal Learning: You’ll learn to develop more positive interpersonal relationships by doing so in the group setting. Sometimes you or another group member will make a mistake in a group therapy relationship, and then we’ll all learn from it together, and turn it into something positive and useful.
  • Group Cohesiveness: You’ll have a sense of belonging to a community, which can help you feel accepted and cared for by others, and can even help you accept and love yourself more.
  • Catharsis: You’ll experience and express emotions through self-disclosure, and gain healing from having others witness them in this process.
  • Existential Factors: This is the good feeling you get from feeling that you are part of something bigger than yourself.

So what do you think? Does that sound exciting and life-changing to you?! Are you ready for group therapy? Contact me to learn more about the groups I’m currently running.

Readiness for Psychotherapy

Deciding whether or not to pursue psychotherapy services can be a challenging task.  Here are some considerations for you to reflect on before reaching out to a psychotherapist.

Am I ready for psychotherapy? 

Psychotherapy has many definitions, but you might think of it as both a service, and a relationship.  Psychotherapy is a method of helping people address challenging emotional and life experiences, and it largely relies on the quality of the relationship between therapist and client.  Psychotherapy requires you to be deeply attentive to yourself, and has meaningful outcomes including increased quality of life, improvements in interpersonal relationships, reduction of emotional distress (for example, depression and anxiety), etc.  Despite these positive outcomes, the nature of the psychotherapy process can sometimes cause discomfort.  I frequently check in with my clients for feedback about how our relationship and psychotherapy process are working, and I take my clients’ feedback seriously.

What kind of psychotherapy am I looking for?

Psychotherapy is a varied field with many different approaches to helping clients reach their goals.  All licensed psychotherapists have graduate degrees in one of a variety of fields, such as social work, psychology, mental health counseling, and others. Beyond graduate school, psychotherapists go on to learn about more specialized methods for providing psychotherapy services, and for this reason, clients may have very different experiences from one therapist to another.  I encourage you to learn about some of the major types of psychotherapy that you may seek out, so that you can find a fit for you.  The American Psychological Association has a helpful resource that summarizes some of the major types of psychotherapy you may encounter:  Psychology Today includes a more detailed list of different types of psychotherapy, that you may wish to consult as well:

Do I need to see a psychotherapist who specializes in a particular kind of problem I’m experiencing?

Some people come to psychotherapy seeking general support as they work towards emotional goals, while others come to psychotherapy with a very particular problem in mind that requires their therapist to be experienced and knowledgeable in treating that problem.  Psychotherapists are mindful of their scope of practice, meaning that if they encounter a issue that they are not qualified to help with, they should refer you elsewhere.  I cannot possibly list all of the specific issues that you may need specialized care for here, and you should consult directly with a psychotherapist to learn more.  Here are some examples of specialized training that I have completed and am prepared to support you with:

  • Gender transitions for transgender and gender non-binary individuals and their families
  • Recovery from traumatic experiences
  • Psychotherapy for very young children (ages 0-6)

If you are looking for other types of services, please contact me to discuss whether I can be of support to you, or whether I can point you in the direction of another psychotherapist.