Demand price transparency for your mental health care, because what you don’t know BEFORE you start counseling can COST you!
Our health care system is broken, confusing and a convoluted profit-driven disaster. It includes large counseling corporations and insurance companies, who too often focus on profit over providing quality mental health care. While you (or I) can’t change the system single-handedly, you can be an informed consumer who advocates for yourself within this system when you demand price transparency for your mental health care.
In a previous post, I covered some essential information to be aware of regarding loss of confidentiality when using your insurance. Price transparency is equally important for you, as a consumer of mental health, especially when using your insurance.
Here are some important facts to know and steps to take BEFORE you attend your initial counseling session:
- Demand price transparency upfront and do your homework prior to your initial session.
- Many large health care organizations and large counseling agencies hide behind a lack of price transparency. They bill you only after several sessions, leaving you with a large unexpected bill to pay.
- The truth is that every counseling organization (large or small) has a contract with each insurance company they are “in network” with. Each contract specfies the EXACT amount of money the agency will be reimbursed for an initial session (CPT code 90791) and subsequent sessions (CPT code 90837).
- As such, first, call your insurance company to determine your mental health coverage details.
- Second, call the counseling agency directly, give them your coverage details, and ask them for the exact cost of your session based on your specific insurance plan coverage. Beware if they are “unable” or unwilling to share that information with you.
- Since there are only a handful of CPT codes used for most counseling sessions: (90791 – initial session, 90837 – 53+ min individual session, 90846 – family counseling without the client present and 90847 – family counseling with the client present), it should be very easy for every counseling agency to tell you your exact cost per session once you have given them the details of your insurance coverage.
Why Demanding Price Transparency is So Important
Here’s a real “true to life example” in my geographic area, that highlights why following the steps above are so important.
- Let’s say you, like so many, have a large $3000 insurance deductible to meet for the year.
- Counseling agency A is a big business run by MBA’s. Because of their size and their business connections, they have negotiated a contract with the insurance company to be reimbursed $380 per counseling session.
- Counseling agency B, a small independently owned private practice just down the street, doesn’t have any negotiating power with the insurance company or important connections. The insurance company therefore will reimburse them at a much lower rate of $130 per session.
- You as the client have to meet your $3000 deductible before your insurance company will pay anything; meaning you will cover the entire cost of each counseling session until you reach your $3000 deductible.
- You find “big business counseling agency A” online and pay $380 out of pocket for each session until you meet your deductible. That means you got only 8 sessions and paid $3040 for those 8 sessions. (before meeting your deductible).
- You could have gone to counseling agency B, a small agency focused on client care, and paid $130 per session untl you met your deductible. You would have gotten 24 sessions for $3120 (before meeting your deductible).
- Choosing Big business counseling agency A meant you paid about 3 times more, for the same service; a 50 minute counseling session!
- But unfortunately you’d never know that until the bill arrives months later...UNLESS you demand price transparency to gather this information ahead of time.
At Full Circle Counseling Services, I always have, and always will continue to be completely transparent with my pricing. I strive to ensure each new client fully understands their insurance coverage and what that coverage means for them in out of pocket dollars BEFORE our initial session.
Because everyone deserves access to affordable mental health care. And nobody should have to endure a shockingly inflated health care bill in the mail.
