Questions and Answers about Using Health Insurance
It is your responsibility, not the responsibility of Dr. Harte, to verify the nature and extent of your coverage. While Dr. Harte may be helpful with this process, he is not responsible for confirming your coverage; this is your responsibility.
Do You Accept my Health Insurance?
Dr. Harte accepts a limited number of health insurance plans. Please click here to see a list of health insurance plans with whom he works.
Does my Health Insurance Cover Behavioral Health Services?
Most health insurance polices cover behavioral health services. Behavioral health services typically comprise mental health services, substance abuse services, and services for behaviorally-based health conditions (i.e., behavioral medicine services for insomnia, sexual difficulties, weight management/obesity, etc). These services are typically covered under guidelines that refer to “medically necessary” services. This usually means coverage for face-to-face appointments in an office for a diagnosable behavioral health condition. Each health insurance company varies in the amount of coverage they provide for these services (i.e., the types of services, the number of appointments, the length of an appointment). Please note: the actual entity that provides the behavioral healthcare coverage may not necessarily be your health insurance company. That is, health insurance companies often outsource their behavioral health coverage to a different managed care company that specializes in these services. These are referred to as "carve out" plans. Because Dr. Harte may not be a provider on these panels, you must check with your health insurance company to find out who provides your behavioral health coverage and what your benefits are.
How Do I Get More Information About my Health Insurance Benefits?
There is usually a toll free number on the back of your insurance card. By calling this number, you can get all the information you need about your actual coverage.
Can I See Any Provider I Choose?
It really depends on your health insurance plan. Most plans limit your selection of behavioral health providers. You must make sure the provider you wish to see is a provider covered by your plan. Note: If you don't want your health insurance company to restrict you from seeing a provider of your choice, you can elect to pay out of pocket for these services and not use your health insurance.
Are There Disadvantages of Using Health Insurance?
Paying out of pocket for behavioral health services can be expensive. Understandably, most people do not want to pay out of pocket for these services if they are covered by their health insurance company. However, before you elect to use your health insurance, you should be aware of potential ways in which this may negatively affect you.
1. RESTRICTIONS & LIMITATIONS.
Health insurance companies significantly limit the services you receive. The health insurance company, not the provider, decides on the number and frequency of appointments, and restricts the length of appointments and the modality of services. Insurance companies also have say in your treatment plan. This often prevents clients from receiving the quality and the convenience of services that they need. By electing to pay out of pocket you and your provider are fully free to decide how often to meet, how long to meet, how to meet (face-to-face, phone, email, skype), and what type(s) or services you would fully benefit from.
2. PRIVACY & CONFIDENTIALITY.
By using your health insurance, you are agreeing to have confidential health information (psychiatric/medical diagnoses and other personally identifiable health information that is required by these companies) sent to and entered into a national data bank. This "confidential" data is then available to insurance companies and, possibly, to future employers (like the CIA, FBI, etc).
3. POTENTIAL CONSEQUENCES.
When you apply for medical, disability, or life insurance, your psychiatric/medical diagnosis will be a factor in determining your acceptance and your rate. A diagnosis of a depressive disorder or an anxiety disorder, for example, could cause difficulties for you. You should weigh these considerations before deciding to use your insurance to pay for behavioral health services.
If you have concern about any of these potential consequences of using your health insurance, you may want to consider self pay. Flexible payment plans can be discussed and rates may be negotiable.
Do I Need Pre-authorization for Appointments?
It depends on your health insurance plan. Some HMOs require pre-authorization, which you can obtain initially by calling the toll free number on the back of your health insurance card. Once the number of visits associated with the initial authorization have been used, your provider is required to submit a form explaining why additional services are needed. Preferred Provider Organizations (PPOs) may or may not require pre-authorizations.
Are All Services Covered by My Health Insurance?
No. The amount and extent of services vary according to your health insurance plan. Some insurance plans cover telehealth services while others do not. No insurance companies will cover therapy conducted via email/texting. Other services such as home visits, court testimony, and collaboration with other professionals are not covered. Length of appointments are typically restricted to about 45 minutes and longer appointments, even if highly clinically needed, are often not allowed. In addition, certain specialized services (e.g., biofeedback) may not be covered by all insurance companies.