Sharmaine D Barnes, LMFT, CEAP
Racial Trauma Specialist
Until lions have their own historians, tales of the hunt shall always glorify the hunter
– African Proverb (Igbo, Nigeria)
Insurance and Your Mental Health
Insurance and Your Mental Health
Although I accept many insurance plans, here's some things you should consider if you plan on using your insurance to pay for your mental health treatment:
Anytime you file a medical claim with your insurance company, whether it is for counseling or a broken leg, that information goes into a national clearinghouse called the Medical Information Bureau (www.mib.com). This information can be used to deny you life and disability insurance—and until the Affordable Care Act, was used to deny health insurance coverage. Due to this fact, and for keeping privacy, many people choose not to file with their insurance for counseling visits.
Health insurance companies require you to be diagnosed with a legitimate and treatable DSM-5 mental health condition in order for them to pay for your treatment. However, not everyone who seeks psychotherapy has a mental illness, but instead may be struggling with life stressors and just need to get back on track.
If I assess and give you a diagnosis your health insurance will then keep it on file permanently. The diagnosis given is entered into the Medical Information Bureau and stays on your record permanently, and as stated above can affect your future. For example, if you seek a job that requires a security clearance, if you would like to purchase a gun, life insurance, etc. mental health diagnoses may be taken into account.
You can get your entire file from the Medical Information Bureau at www.mib.com. It lists your date of service, doctor name, and diagnosis.
Some Insurance companies and Employee Assistance Programs (EAPs) will usually authorize a specific number of sessions that they will provide payment for. However, in my experience, there is no "one-size-fits-all" when it comes to therapy. Clients have varying levels of severity with their symptoms and obstacles that are unique to their life experiences. Having an insurance company dictate that we need to get all of your issues resolved in x amount of sessions puts unnecessary pressure on the both of us. I also don't want to leave you without our work completed because the insurance company thinks you don't need anymore treatment.
Some insurance companies reimburse therapists at a very low rate--typically much lower than the set fee from the clinician. This makes it hard to do good work with clients when your therapist may be worrying about how she is going to pay their bills and sustain their practice. Insurance companies can also take 30 days or longer to reimburse their providers. Imagine if you did not know when your employer was going to pay you, or even worse, told you after a while they decided they aren't going to pay you.
Your treatment remains confidential when you do not use insurance. If I am not billing your insurance company, the information about your treatment remains confidential between you and I unless you wish to release that information to another party.
Insurance companies want a lot of information about you and your treatment, and require your therapist to update them on your progress frequently because it is their money after all. Be advised that I would have to speak to a complete stranger on the phone who may or may not be trained in mental health treatment, and who is putting information in their company database about you, and who determines whether or not the therapy is helping you.
I've provided you the aforementioned information so that you can make an informed decision regarding whether or not you want to use your health insurance to pay for psychotherapy services.
If, however, you are still interested in using your health insurance please check your coverage carefully by asking the following questions of your health insurance company:
- Do I have mental health insurance benefits?
- Do my mental health insurance benefits include teletherapy?
- Is Sharmaine Barnes an "in-network" mental/behavioral health provider under my plan?
- What is my copay?
- What is my deductible and has it been met?
- How many sessions per year does my health insurance cover?
- What is the coverage amount per therapy session?
- Is approval required from my primary care physician?
***Most health plans are authorizing teletherapy services due to the COVID-19 pandemic; however, please check with your specific plan to make sure teletherapy or telehealth is a covered benefit. Please be advised that the list of insurance plans I accept is constantly changing because I closed my commercial office and some insurance plans require that I maintain a commercial rather than virtual office in order to remain in their network.***
Insurance Plans Accepted:
Aetna/Aetna EAP
Beacon Health Options/Value Options
Blue Shield of California
Cascade EAP
Cigna/EAP
Claremont EAP
ComPsych EAP
Concern EAP
Health Plan of San Joaquin Medi-Cal
Humana
Kaiser Permanente of Northern California (I'm a direct community provider)
Magellan Health/Magellan Health EAP
MHN/HealthNet/EAP
Networks By Design
Open Path Collective
Optum/EAP
Unicare EAP
United Behavioral Healthcare
If you do not see your insurance plan listed, you can contact your insurer to see if you have "out of network" mental health benefits or request that your insurer contact me to discuss a "single-payer agreement."
Payment
Payment for services must be made at the time services are rendered. Visa, MasterCard, American Express or Discover Cards are accepted for payment.
Cancellation Policy
If you do not show up for your scheduled therapy appointment and have not notified me at least 24 hours in advance, you may be required to pay the full cost of the missed teletherapy session.