Understanding Mental Health Insurance Coverage
Navigating insurance can be challenging, especially when understanding what’s covered for mental health services. At Kona Counseling, we want to make this process as smooth as possible for you. Here’s a breakdown of what you need to know about insurance coverage for mental health.
Mental Health Coverage Varies by Plan
Every insurance plan is different, and so is the way it covers mental health services. While most plans do include mental health coverage, the specifics can vary greatly. It’s important to review your plan’s details to understand what’s covered and any potential limitations.
Copays May Differ
You might notice that your copay for mental health services differs from what you pay when visiting your primary care doctor or a specialist. Insurance companies often set different copay amounts for mental health visits, so check your plan’s details before your appointment.
In Arizona, copay amounts typically land between $0 to $120 per session.
Counting Toward Your Deductible
In most cases, mental health visits will count toward your annual deductible. Here’s how it works:
What is a Deductible?
A deductible is the amount you must pay out of pocket for healthcare services over a year before your insurance begins to cover a larger portion of the costs. For example, if your deductible is $1,000, you’ll need to pay $1,000 for services before your insurance starts paying a higher share of the cost.
It’s customary for employers to choose a January or July start for their insurance plans. Unsure when your deductible renews? Checking with your HR department is your best bet. Or think about when your company opens enrollment. This process typically happens in November/December for plans that renew in January and May/June for plans that renew in July.
How Mental Health Visits Impact Your Deductible
With Most plans, every time you have a session with a mental health professional, the cost of that session is applied to your deductible. Until you reach your deductible, you’ll be responsible for some of the cost of each visit. After reaching your deductible, your insurance will typically start to cover a larger portion of your therapy costs, which means your out-of-pocket expenses should decrease.
In-Network vs. Out-of-Network Deductibles & Costs
It’s also important to know that many insurance plans have separate deductibles for in-network and out-of-network providers. In-network providers have an agreement with your insurance company to provide services at a reduced rate, while out-of-network providers do not. If you see an out-of-network provider, you may have a higher deductible or be responsible for a larger portion of the cost. Check out our page on in and out-of-network services for more details.
Who Decides What I Owe?
Please note that your insurance company has the final say on what you owe out of pocket. While we verify coverage and receive accurate information 99% of the time, copays may occasionally change after we submit the claim. We are contractually obligated to charge what your insurance company determines, no more no less.
What is a Superbill and How to Use It?
A superbill is a detailed invoice provided by your therapist after a session, which includes essential information about the services you received. It’s not a bill in the traditional sense but a document you can submit to your insurance company to seek reimbursement for therapy sessions, especially if you are paying out-of-pocket. Think of it like a receipt you’re going to submit to your insurance company in order to reimburse you for your medical costs.
What’s Included in a Superbill?
A superbill typically contains the following information:
- Client Information: Your name, date of birth, and other identifying details.
- Provider Information: The therapist’s name, credentials, National Provider Identifier (NPI), and contact details.
- Session Details: The date of service, type of therapy provided, duration of the session, and a description of the services rendered.
- Diagnosis Code: A code representing your clinical diagnosis is necessary for insurance purposes.
- Procedure Code: A code that describes the specific therapy service provided.
- Fee for Service: The amount charged for the session.
How to Use a Superbill
- Check Your Insurance Coverage: Before submitting a superbill, check with your insurance provider to ensure they cover out-of-network mental health services. Understand your policy’s requirements for reimbursement, such as deductibles, copays, and the percentage of costs covered.
- Submit the Superbill to Your Insurance: After receiving your superbill, submit it to your insurance company following their specific instructions. This might involve filling out a claim form and attaching the superbill through mail, fax, or an online portal.
- Wait for Reimbursement: Once the insurance company processes your claim, they will determine the amount they will reimburse you based on your coverage. They will send you a payment or a statement explaining the reimbursement details.
- Keep Records: It’s important to keep copies of all superbills and related correspondence with your insurance company for your records.
Using a superbill can help offset the cost of therapy if your insurance provides out-of-network coverage. It’s a straightforward process allowing you to receive the mental health care you need while lowering your out-of-pocket expenses.
We’re Here to Help
Understanding your insurance coverage is crucial to maximizing your mental health care. If you have any questions or need assistance, our team is here to help you navigate your insurance benefits. We recommend contacting your insurance provider directly for the most accurate information. Still, we’re happy to assist in any way we can.
At Kona Counseling, we believe everyone deserves access to quality mental health care. We’re committed to helping you understand your insurance coverage so you can focus on what matters most—your well-being.