This information is designed to help you with commonly asked questions about the use of health insurance to pay for mental health services at Transitions.
If I have health insurance do I have to use it?
Yes, most of Transitions’ funding sources assume that people who have health insurance will use their insurance benefits FIRST before we tap into funds designed for uninsured individuals.
Can I pay out of pocket instead of using my insurance?
Yes, however you would not be eligible for a reduced fee reserved for uninsured people.
Can Transitions help me figure out if my health plan covers mental health services?
Yes, Transitions staff can help you with making this determination. If you are new to Transitions, the Customer Services Manager can help you at 217-223-0423 x 326. If you are already receiving services at Transitions, you can call the Business Office at 217-223-0423 x 311.
What if I want to look into my benefits myself before my first appointment?
If you are employed, you might want to ask your employer if the company offers an employee assistance program. Sometimes these programs are run independently from health insurance plans and Transitions participates in several EAP plans.
To look into health benefits specifically, look at the back side of your insurance card and look for a phone number for “Behavioral Health” or “Customer Service.” You can call this number before your first appointment and inquire about “outpatient mental health benefits.” On that call you should learn about your health plan benefits, including:
- Pre-authorization: Some plans require either the client, or the provider, to answer several questions about the proposed treatment, and then will authorize payment for psychotherapy sessions. Sometimes insurance companies authorize sessions 5 or 10 at a time, others authorize sessions for a full year. It is important to have these authorizations secured BEFORE treatment starts in order to avoid denial of coverage. Because sessions can get expensive, we encourage clients to ask about authorizations several times, i.e. “So, I just want to make sure that I DO NOT need an authorization before I see Mr. Smith?” just to make sure everyone is “on the same page”. You should also inquire about the plan requirements for education or licensure of the person delivering the service. Many require a counselor to be a Licensed Clinical Social Worker (LCSW) or a Licensed Clinical Professional Counselor (LCPC).
- Deductible: Some plans require clients to pay a certain amount out-of-pocket before their benefits kick in. It is important to know several things about deductibles: 1) If you have one; 2) How much it is; 3) What is applied to the deductible; 4) How much of your deductible have you already met for this year; 5) When does the deductible re-set (some re-set on January 1st, others at the start of your employer’s fiscal year, etc).
- Co-Pay: Most plans require a co-payment or co-insurance that is payable to the provider at the time of service. Sometimes this amount is set (i.e., $15) other times it is a percentage of the provider’s fee. This might be another question to ask your insurance company several times just to make sure you know what your share of the cost of treatment will be.
- Number of Sessions Per Year: Most plans cap the number sessions for psychotherapy services. This number is important to keep in mind when planning frequency of sessions with your therapist. Tip: make sure someone (presumably you or your provider) is keeping track of the number of sessions you use as the year goes on – un-reimbursed session fees can add up quickly.
What information will Transitions release about my mental health services to my insurance company?
Transitions follows state and federal confidentiality laws concerning your health information. However, almost universally, HMOs, managed health care and insurance companies will require a mental health diagnosis before they will pay for a mental health service. Many companies also demand detailed information about your life before they authorize payment. Some people have concerns about how the application of a mental health diagnosis might effect them in the future. For example, as insurance companies increasingly centralize their records, they provide access to multiple sources that are not policed by any external agency and are essentially on their good behavior to not misuse their access to your records. While the choice will be yours whether to use your insurance to help pay for your mental health services, if you elect not to use your insurance, you would have to pay out of pocket at full price.
When is payment due?
Transitions requires payment at the time of services. When you come for your appointment, we will have an estimate of the co-pay or deductible that you are required to pay at that the time of service. We will then submit the remainder to your insurance company. If there is a balance still remaining to be paid, based on the insurance company’s payments, we will send you a statement in the mail.
How can I tell what insurance paid?
We encourage you to look for the Explanation of Benefits (EOB’s) you will get in the mail about our sessions. If you’re not sure what these are, they come from your insurance company and say “THIS IS NOT A BILL” at the top. We think it is crucial to be an informed consumer and customer of both our, and the insurance company’s services, and checking out the EOB’s is a great way to do that.