After a decade in community social work and private practice, I am comfortable saying that I love health insurance. Once I began to understand the intricacies, having a knowledge of this aspect of private practice has proved invaluable. I help clients and colleagues alike to navigate their benefits. So, don’t be afraid of the topic and instead think of it as anything else we do in mental health. You can tackle out-of-network billing questions with a few “coping skills.”

Insider’s Tip: Don’t be intimidated by health insurance lingo. You can use this to identify coverage quickly!

As therapists, we can rely on the initials HMO and PPO as the roadmap to knowing how to support a client with accessing their Out-of-Network benefits. I typically will ask a prospective client to send a photo of the front of their insurance card or simply ask them the name of their plan.

Most Americans have what we call a Preferred Provider Plan (PPO). This type of plan allows the consumer to choose their “Preferred” licensed therapist, and this is an amazing benefit. Each PPO plan will allow for a certain percentage of their cost of therapy to be reimbursed. Most plans reimburse by a percentage and are written as such: 60/40, 70/30, etc. This information is often also printed on the front of the card, or on the first page of the policy. Clients can be reimbursed this allotted percentage of each session.

So here is some “Therapist Math” as an example:

“Sara is a new client. She has a PPO plan from her job. When she chose her plan last year, she chose a 60/40 plan because it was a good value for her and her family. Now that Sara wants to begin therapy, she has found an amazing therapist and is ready to begin.”

If you are the therapist, you immediately are able to know that Sara’s plan will cover 60% of the cost of your fee. Sara will be responsible for 40% of your fee. If Sara has a deductible, her health insurance company will “pick up the tab” after she meets that deductible.

When I explain deductibles, I always explain in terms of car insurance. For some reason, people are much more comfortable in understanding this topic than mental health coverage. If you have a car accident, your car insurance company will pay for the repair AFTER you meet your deductible. Of course, you choose that deductible when you buy your plan. This is identical to deductibles for healthcare.

Now you can see how your session fee will be drastically discounted for Sara solely by using her existing health insurance benefits to cover 60% of the cost. Many plans will pay a higher percentage, but as a therapist, I love to inform my clients that they can see a 60% savings from my fee. Not only that, but by billing her out-of-network benefits, the therapist does not have to navigate the headache of insurance credentialing and can provide better quality care.

Some Americans will have an HMO insurance plan. This type of plan is often more budget-friendly but is much more restrictive. If I meet with a prospective client that has an HMO plan, I always encourage them to choose a more flexible plan and then they can receive more coverage of my fee once their new plan begins for the year.

We all know that the therapist-client relationship is strong. So, remember your value as a clinician. Your clients will appreciate your willingness to help them navigate their benefits, and even those with an HMO plan will spread the word about your clinical skills and your practice will thrive.

Things Aren’t That Bad: 5 Reasons People Give to Avoid Getting Professional Help

According to the National Alliance on Mental Illness, 1 in 5 adults experience mental illness, but not all of them seek out professional help. In fact, nearly 60% of adults with mental illness do not seek mental health help. With a seemingly endless list of consequences, not getting help for mental illness can result in increased dependency on substances, increased risk of suicide, disruptions in your everyday life, and much more. Even though it is dangerous to avoid getting professional help, many adults still do. Below are five common excuses for avoiding therapy… and reasons to push past them. 

Common Excuses to Avoid Therapy

#1: “Things Aren’t as Bad as They Seem.”

Even if you’re dealing with a myriad of mental health-related issues, it’s very common for you to tell yourself and others that things are really not that bad. This excuse is often used when other individuals in your life point out differences in your behavior or notice you are going through a difficult time. Even though you are showing noticeable changes in your normal self, saying things are not as bad as they seem is an excuse that seeks to diminish those concerns. But this excuse suggests a “tough it out” attitude about mental health issues, which often doesn’t lead you out of those issues, but merely allows them to persist. You don’t have to suffer alone. 

#2: “Therapy Is Too Expensive.”

A common concern and excuse for avoiding professional help is the cost of therapy. Yes, therapy can be expensive, but not always. Depending on several cost factors, insurance may make it more affordable than you realize. Some therapists offer sliding scale rates, meaning that they have room in their practice for clients who need discounted rates. There may also be affordable and accessible mental health services in your area, just waiting to be explored. 

#3: “I Don’t Need Therapy.”

Sometimes we view professional help as a luxury or something that should only be used by people who suffer from seemingly “worse” mental health conditions than whatever we’re dealing with. The truth is, most mental health issues that adults experience are not considered severe at first, but they can become dangerous if left unattended. For example, mild depression or anxiety, left to fester, can grow into major depressive disorder. Seeking professional help can help you get your symptoms under control before they become overwhelming or dangerous. 

It’s important to note as well that constantly living in state of stress, depression, or anxiety can actually do a lot of harm to your everyday life. You don’t have to “hit rock bottom” for your struggle to be worthy of attention and care. You matter, your quality of life matters, and pursuing your own mental health is worthy no matter how things are going.

Keep in mind the ripple effects of learning better coping mechanisms, healthier ways of interacting, a strong self-image, and direction in personal growth over time. Learning to fight better with your partner, replacing your negative self-image with a positive one, or recovering from childhood trauma are treasures that you will take into every day for the rest of your life.

#4: “I Don’t Know Where to Start.”

If you don’t know where to start in seeking professional help, there are two great places to go. If you have an insurance carrier, you should start by calling them. The number of your insurance provider can usually be found on the back of your insurance card. You can learn more about your coverage for services and receive recommendations about covered professional help in your area directly from them. The second option is to look at an online directory of therapists. Here, you can find a list of therapists in your area who are ready to help.

#5: “I’m Too Busy.”

We all know that life can get busy, and it can seem like we do not have time to spare. This can feel especially true when we’re considering something we do not really feel excited about. But making time to get professional help is worth it. With the support of a therapist, you can learn to manage your mental illness, pursue personal growth in a way that frees you to be your best self, and let go of things that just aren’t serving you. There is always time for that. 

It Is Time to Get Professional Help 

No matter your situation, if you’re struggling with your mental health, you should seek professional help. To learn more about a therapist in your area who is ready to help you, click here.