Kinder Mind
Kinder Mind
Understanding Insurance: Using Your Benefits for Mental Health with Michele Riley
Ever grappled with the intricacies of mental health insurance? Well, struggle no more as we bring Michelle Riley, an expert in mental health and insurance billing, to simplify it all for you. Michelle opens up our conversation by unraveling the complex world of health insurance for mental health care. She takes us on a journey through the types of mental health services covered and demystifies the workings of co-pays, deductibles, and premiums as they relate to mental health coverage.
Our discussion takes a deeper turn as we step into the realm of in-network and out-of-network providers. Michelle sheds light on the pros and cons, assuring us that sometimes, opting for out-of-network can be the best option for your mental health needs. Ever wondered how to verify if a provider is in-network or accepts a certain insurance? Michelle has got you covered on that too.
As we round up our enlightening chat, Michelle shares the secret to maximizing your mental health insurance benefits. From understanding your insurance tracker and saving your explanation of benefits (EOB) to utilizing the provider portal, she has you covered. She emphasizes the need to stay vigilant as insurance companies can sometimes make mistakes. Be sure to tune in for a detailed breakdown of how to not just navigate, but conquer the world of mental health insurance. Remember, your mental health journey should be about focusing on your wellbeing, not worrying about the financial side of things. We're here to help you make that a reality.
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Welcome to the Kindermind podcast, where we're devoted to opening up conversations and destigmatizing mental health. We'll bring you interviews with practitioners in the field of mental health, researchers uncovering new knowledge and best practices for treating mental health disorders, and individuals sharing their mental health journey. All right, today we have the pleasure of talking with Michelle Riley. Michelle has been in the world of mental health and insurance and billing for a number of years, so I'm so excited to have her as a guest on the show to really break down all of the un they're standing around using your mental health benefits through your insurance, what that means, what that looks like out of network in network, all of these things that you might hear if you try to use your insurance benefits to cover mental health therapy. So Michelle's just going to walk us through and give us a nice understanding of what that looks like, so that you're not afraid to access those benefits and that you are informed. Thank you so much for joining us today, michelle. It's great to have you on the show.
Speaker 2:Thank you, I'm happy to be here.
Speaker 1:Yes, and we are happy to have you here. So to kick us off, can you explain kind of the basic concept of health insurance and why it's important for mental health care?
Speaker 2:So health insurance was designed to protect us and our families, to make sure that we don't get hit with high health care bills. It's very important to have health insurance for many reasons. You get access to more care, you get access to more facilities, you get access to more type of different physicians and specialists, and the out of pocket cost is not as much as if you would be paying out of pocket with no insurance. So it's very important. Mental health, very important for mental health. It's been quite a few years now that insurances have now accepted mental health as one of the medical conditions where they cover at the same amount of coverage as they would any other type of medical conditions. So mental health has came a long way with insurance. It's very, very good now.
Speaker 1:Awesome. So then, what type of mental health services are typically covered by health insurance plans?
Speaker 2:So right now. So outpatient care, which could mean individual therapy, family therapy, marriage counseling, as well as group therapy. That's actually really a new one that just started to get covered by mental health benefits. Very, very good, and before they would not cover group therapy, and I'm very happy they are. Substance abuse Substance abuse has come a long way, so now more clients can get help if they're dealing with a substance abuse diagnosis. We also have in IOP, which is intensive outpatient. That is more of staying in an office for a longer amount of time, included with seeing a psychiatrist getting access to a lot of group therapy. That is also being now covered by insurance. You have inpatient where you have to stay. If you feel that you're just outpatient and group is not working for you, you can go inpatient. That is now covered. Medications are covered, psychiatry is covered, psychology is covered. So they now have covered every single part of mental health.
Speaker 1:That is wonderful. Definitely there's a huge need. So I'm glad the insurance company finally got on board and decided hey, we're going to do this for our members, our customers, our people that pay us. So that's really great to hear. So now the convoluted parts. At least for me who is not in the world of insurance and I admittedly struggle with my own insurance and understanding all the things Can you tell us how co-pays, deductibles and premiums work in the context of mental health and coverage?
Speaker 2:Sure. So whenever you sign up for any type of health insurance, you receive a packet and inside that packet you have to look over all the benefit types and all the premium types that you would want to sign up for. So that is all different amounts of premiums. So you're able to review that packet Because in that packet you also see something called deductibles, co-insurances, co-payments at a pocket cost. This is where it gets confusing. So let me start by saying the higher your premium, the less you're going to have to pay out of pocket for services. So that's actually a very big key to people that kind of don't understand the lingo of insurance. So if your premium, your premium, is what you're going to pay a month for your insurance, the lower your premium. I'm sorry. The higher your premium, the lower your benefits would be. So I'm going to give you an example. So we have something called a deductible. A deductible is the most confusing, I can say, aspect of insurances. A deductible is an amount that an insurance makes you responsible for before they're going to pay any out-of-pocket costs to your insurance. So if you come into a doctor's office and you have a $2,000 deductible, that deductible is your responsibility until it has been met. That means you would have to pay into it to meet it. So if you're seeing a doctor that charges $200 and you haven't met that deductible, that $200 is going to get applied to your deductible, saying that you now have to pay your doctor the $200 out-of-pocket. And it keeps going on and on and on like that until you reach $2,000. Now anything, any service that you've done, lab work, any type of, for instance, radiology, x-rays, mris, cat scans, any other doctor visits that all goes into that deductible pool. So it's just not for your mental health. It's everything in one. So it's always good to keep track of your deductible. Also, some plans the deductible is not only an individual deductible can actually break down in two. So you have an individual deductible and a family deductible and whichever deductible is met first, that's the deductible that they will. Once it's met, they will go ahead and start paying your clinician, your doctor, your therapist, anybody that you're seeing.
Speaker 2:So where a lot of people get confused with deductibles is when they come into an office. They think, oh well, I have a deductible but I also have insurance and I have a copayment. Copayment and coinsurance does not pick in until your deductible is met. So you have to meet that deductible. That is the first line of the fence when you're coming into insurance using your insurance in a doctor's office. So you have to have met that deductible. This is very important.
Speaker 2:Once your deductible is met, we move on to do you have a copayment or do you have a coinsurance? Okay, deductible is 100% met. Now the insurance is saying you don't have to pay 100% of the visit because your deductible is met. But we are now applying a copayment or coinsurance, which is a portion. Coinsurance is a portion of the visit and a copayment is in a set amount that you're going to pay for that visit. Every visit. That can range anywhere from $1 to I see them as high right now is about $80. Coinsurance is a percentage. That percentages Okay, you're responsible for 20% of what your insurance allows. It's very similar to a copayment is just a percentage. So copayment is a number amount, a coinsurance is a percentage. So it's good to know which one you're going to be responsible for, because then that makes a difference when you're paying your costs at the front desk of any of your visits.
Speaker 1:Have you ever? Is it ever a thing where you have to pay a copayment and coinsurance, or is it one or the other?
Speaker 2:No, it's going to be one or the other. It can never be both. So deductible is going to be there, but copayment and coinsurance will never be together. It's going to be one in one and that will be in your benefit package that you receive from your insurance company. Once you pick the premium You'll be able to say okay, I want to do a coinsurance, not clearly a coinsurance. You're going to end up paying more money than what you usually pay. With a copayment because you're paying a percentage, and that's where the premium that you pay per month comes into play. Again, the higher your premium, most likely you're going to have a copayment and not a coinsurance, because coinsurance change with every specialty and every service. A copayment usually won't. So if you come for a visit you know a 30 minute visit, say, with therapy, a 45 minute your co-payments are going to stay the same throughout any time frame. A co-insurance is going to change because the amount billed to the insurance company is going to be higher. So your percentage is going to be higher because it's percentage-wise Okay.
Speaker 1:That makes a lot of sense. Then, if you do have a co-payment, no matter whether you're doing a 30-minute therapy session or a 60-minute therapy session, you're paying the same amount of money for your co-payment, exactly.
Speaker 2:The only thing that changes is the amount billed to the insurance, but that has nothing to do with the client Co-insurance. It will have something to do with the client because the higher the bill is, the more percentage they have to pay.
Speaker 1:Okay, that makes a lot of sense. Now I know I've kind of seen this question floating around out. There Are providers who and I guess this will kind of segue us into a nice net conversation about in-network and out-of-network but are providers who are in-network with an insurance company required to take that co-pay from the client?
Speaker 2:They are required by the insurance law we call it to take the co-pay just because they signed a contract with the insurance company for that rate and they're required to collect it from the patient. There are cases where a patient's not going to be able to pay that, which then it has to be working with the office and we have to have something in writing from the patient why and we have to report it to the insurance company it is required Deductibles in-network, and co-payments and co-insurance are required to be collected at all times from the clients.
Speaker 1:Roger, thanks so much for clearing that up. Now, thinking about in-network and out-of-network, that's another place where I've personally struggled. I don't even know if I have out-of-network benefits. We have tricare military, so I'm not sure. Maybe, maybe not. Can you tell us a little bit about what it means for a provider to be in-network or out-of-network and what that means in terms of are you still able to see that person or not?
Speaker 2:In the sense of the provider. We'll start there. A provider that wants to be in-network is basically signing a contract with a contract that rate from each insurance company. That means that the insurance company is not going to pay the provider more than what the insurance contract is, no matter how much of provider bills. The bill can be sent for $1,000 for a certain code, but in that contract you're a contract that's $75, and that's all you're going to get.
Speaker 2:Now, when you go out-of-network for providers, you're not abided to any contract. It's an open contract. There's no negotiated rates. They will pay what they think is best for the service, based on what you pay. With the physician charge you can't charge outrageous amounts, but they do pay a lot higher to the providers if they were to go out-of-network. We'll go into a sense of why out-of-network sometimes is best. It don't sound good by me saying that the providers probably get paid more and most likely get paid a lot more, but there's a reason behind all of that Going into it for a client. I like the fact that clients get to choose if they want to go in or out-of-network.
Speaker 2:Going in-network and I'm just going to blurt this out so everybody can understand is an in-network office is going to be one a lot busier. That means that the appointment times are harder to get. It's just very hard. It's harder to get in-network office than an out-of-network office is where I'm getting that. The care is a little bit different because providers make a little bit more money off of out-of-network. Their offices are going to be nicer.
Speaker 2:Well, supposedly this is how it's supposed to be Nice. They can get in a lot quicker. They can do any service out-of-network. They're not contracted to anything. That means they can provide anything they want, any pamphlets they want. Everything is covered by the insurance company out-of-network. In-network you only can do the codes they say you're allowed to do. That means that you don't get the opportunity to the different services that added network can provide you. Now the downfall of added network is the deductibles are a lot higher. Added network. Some plans don't have added network. Like you said, your tricare maybe. It doesn't have added network. I can tell you tricare doesn't have added network.
Speaker 1:Okay, good to know.
Speaker 2:Tricare has added network and their added network is very good. The deductibles are higher. Added network which means that offices are allowed to collect those deductibles up front. If you go into an office that means that you're going to have to pay $300 out of pocket. I mean I have seen added network at $500 deductibles. That's very low because the deductible started 100 up. But if you have a high deductible $5,000, $10,000, these deductibles can raise very high added network.
Speaker 2:But the provider once again, they're not contracted with the insurance companies. They can work with your deductible and work with anything within them benefits any way they like. They can charge you. They don't have to charge you. They're not required to collect anything. There's no such thing as co-payments with added network. It's all co-insurances. They don't have to charge you nothing. They can see you and work out a payment plan with you if they want, because once the insurance does pay, it does pay more. A lot of providers now add a network. They waive a lot of the deductibles and half of the deductibles. Does that make sense to you as a civilian understanding this in and out of network? Because I know it can be a little confusing.
Speaker 1:It does. It sounds like for in network, I know no matter what for tricare at least, I'm not going to get a bill. If I did have a co-payment, I know that I'd pay my co-payment. Insurance would take care of the rest. Then it sounds like for out of network, it's all going to be dependent on the provider and how much my insurance is going to pay that provider, and then I'm going to be responsible for the rest.
Speaker 2:Correct. If the provider wants to charge you for the rest, they don't have to. When you're seeing an added network provider, it is. You have to ask all the questions. You have to ask okay, I have this deductible, will I be responsible for the whole deductible? Will I be responsible for the co-insurance, or do you work that out with me? Most providers that see clients at a network, they individualize financial plan with each client. Another amazing thing for clients is you can go anywhere in that state for at a network Anywhere. That means that you don't have to go to just in network. They have their providers and this is the only places that you can go to Add a network. You can go anywhere you want. You got to be within the state because the provider is a license in that state, but you can go anywhere you want. You do not have to go to a certain provider because the insurance said so.
Speaker 1:Okay, that makes a ton of sense. How can individuals verify let's say they don't want to do the out of network, they're worried about getting a bill or having that financial liability? How can clients verify if a specific therapist is in network or accepts their insurance?
Speaker 2:I always tell clients on the end of the billing is just because you called the office to verify your benefits. You should always check your benefits yourself because they're different, usually on the clients and then RN, they all come together the same, but usually the members area. They have more accurate information than we would do on the provider. Then First thing you should do is call your provider's office, ask the questions Okay, if I have a deductible? And my response is what hold deductible? Are there payment plans? Do you collect the whole coinsurance amounts? If I met my out of pocket amount, do you still collect your coinsurance? You just got down all the answers Immediately after you hang up, you call your insurance company.
Speaker 2:You want to know, okay, what is my deductible, how much have I met so forward towards where my out of network deductible, what's my coinsurance and what is my out of pocket and how much have I met so with that out of pocket. All of these factors are very important when you think of your finance issue. If you have any issues with finances to go out of network because out of network can get a little expensive Same thing in network you want to ask the same questions. Just because you're deductible, you still want to know what's met in network. You still want to know what's met to a degree, out of pocket. You do want to also know if you have a co-pay or coinsurance so that you know when you get to that doctor's office, you know what you're going to pay.
Speaker 2:So definitely a lot of people like to go online and check the benefits. It's quick but it's not efficient because they don't update your benefits every day. You could have had a procedure yesterday that still hasn't been reflected on your bill because the providers can. They have up to 60 days to bill. So it's always good to call your insurance company and talk to them and have somebody give you the benefits and give you a reference number.
Speaker 1:Okay, that's really great advice. I never even thought about that because we, you know, with technology where like, oh, okay, I can just log in and I can just check this for myself. But you're absolutely right, if you want that most updated snapshot of your benefits and, you know, fill that piece of mind of I had a person on the phone with a reference number tell me this information, then, for any reason, should that information turn out to be false or inaccurate, you've got a leg to stand on for. You know, calling the insurance company and trying to get a resolution.
Speaker 2:You're absolutely correct. They have to honor it, and electronic is one of the best things that's ever created is our electronics. But let me tell you how much we depend on them and how much they are wrong half the time. So, something this important, you're going to want to speak to somebody and get a reference number.
Speaker 1:Absolutely. That's a really great point. Thanks so much for sharing all that. Another question I hear a lot are their limitations or restrictions on the number of therapy sessions that a client can have under their insurance plan?
Speaker 2:So it's based on your insurance plan. We came a long way with insurances where up to even three years ago they you would have to get authorization and then they'll only give you eight visits and then you have to call back and tell them your life story all over again and where you're at in treatment or your clinician have to do that, especially for mental health, and then they'll give you another eight visits and this is kind of keeps on going and they'll cap you at a certain amount per year. Now a law is passed where they're not supposed to do that anymore. So now you can be seen up to three times a week, even four if you have authorization for mental health, and that includes individual therapy, family therapy, group therapy, now IOP. That is on another level. We're just talking about outpatient. You can be seen up to three times. With that included medication management, that can be your fourth visit. You can be seen the whole week.
Speaker 2:If you're you doing different things. There's a new visit to your year that does not exist anymore. The only thing that changes this is if you are using an EAP, which is an employee assistance program. That is where your employer offers their employee assistance program through a certain third party insurance or part of, for instance, your non-healthcare. And sigma have it, and Etna now has it as well, where they'll give you three visits for just they'll pay. Your employer will pay through the insurance, through visits, but after that your CAF, then you have to use your benefits or you have to call in and get recertified again to see if you can get some more visits. So now EAP is the only thing different, even your Medicaid plans. You have unlimited visits for mental health now.
Speaker 1:That is phenomenal because I remember hearing back before I was in network with anybody. I remember hearing a lot of frustrations from the provider side and the mental health community that it seemed really restrictive for them to have to really justify to the insurance company like this person is struggling with their mental health, they really need this level of support and to try to get those sessions covered. And then from the client side, who's already dealing with this overwhelming journey of mental health and like the burdens that come from just trying to get better and feel better, and now they're having to really divulge all of this extra information to an insurance company to try to get these sessions approved. So that is so great to hear that they're no longer limited in the absence.
Speaker 2:No, no, even psychological testing is covered without authorization, and even substance abuse. That came a long way. People were not getting help because there was no coverage for substance abuse Two, three years ago and now there's coverage for it. Now I had a network covered it, but they would not cover it in network. Medicare still doesn't cover substance abuse. They're the only ones that are still lingering. What substance abuse? Other than that, every other insurance company will cover it.
Speaker 1:Okay, very good to know. So, thinking about coverage and payments and deductibles and all of the things, can you help unpack this mysterious word that I know I hear a lot? And I will immediately raise my hand and admit that I'm just as guilty as probably a hundred percent of our clients. When I get this little thing in the mail called an EOB, I don't even open it most of the time and it goes right in the trash.
Speaker 2:What is an?
Speaker 1:EOB or explanation of benefits. Why should I not throw it in the trash? What does it all mean?
Speaker 2:Well, that is your tracker. It's like your paste of when you work. It's tracking everything. It's tracking if your deductible has been met. It's usually at the bottom of the EOB. It's tracking what?
Speaker 2:So let's start with. It tracks the visit that you were seeing. Every visit that you were seeing by a provider is. They're going to send you an EOB every time or you're going to get it electronically or in the mail. It's going to have that date. It's going to have the provider that you're seeing. It's going to have the service that was done. It's going to have what the provider is going to charge you or going to charge your card on file. It's going to have your deductible amount If it went towards where you deductible or if it paid the provider directly.
Speaker 2:If it goes towards where the deductible, then that's your responsibility to pay that provider. Or if you sign something saying that we can charge the card on file, us billers will charge the card on file for that deductible. It's going to let you know what they paid the provider, if they paid the provider anything at the bottom. It's going to calculate how much you met towards where you're at a pocket. Let me tell you you're at a pocket so important because once you meet your out of pocket you have no more co-pays for the rest of the year. You have no coinsurance for the rest of the year. Your appointments are covered at 100%.
Speaker 2:Now you want to track that because providers can't track that. They don't Updated enough in the system where we're going to know all this patient met at a pocket. We don't know until you tell us what. We get an EOB saying it was paid at 100%. Then sometimes we have to refund the patient. So it's always good not to throw that away because you'll know exactly what your provider did. This is really big in emergency rooms, not even outpatient, because we all know the emergency room do charge a lot. So I've had so many calls before working in emergency medicine where like okay, this was double charge, this was triple charge. I didn't get this done because everybody's moving so fast in emergency room. They were supposed to get it done but now they're getting charged for it. So you want to read your EOB and you want to save them because that is like your encyclopedia of the insurance world and also your medical history of how much went towards the word anything of your insurance. So you never want to throw them away ever.
Speaker 1:Okay, lesson learned. Yeah, as soon as I heard it's like a pay stub, I was like, okay, this is an important document.
Speaker 2:You know how you track your taxes on your pay stub and you track how much you got paid and how much they took. That's exactly like a pay stub and a lot of people and they do add a lot of, I can say, like excessive blue crosses. It's like six pages. The most important page is like one page. You can throw the rest away, but the page with everything on it you're going to want to keep.
Speaker 1:Okay, good to know. I will not throw another one away. So how can someone like myself or any of our listeners who are wanting to use their health insurance for mental health services? How do they handle the billing and the claims? Is there anything they need to do other than you know, just calling their insurance company to verify their benefits? Is there anything they need to do on their end to use those benefits?
Speaker 2:The most important thing is be very active in your billing so you know you have your office, you have your front desk staff that check benefits, you have your bill that it bills out. But it's always helpful when clients check their benefits themselves too to compare so that there's no conflict when the bill comes Like, oh, I got charges deductible I shouldn't have. And then you know us as billers are like well, this is what your insurance said and they're like well, my insurance said something different. So it's always good for the members to make sure they know what's going on and to understand that the insurances do make mistakes. They're not perfect and never, ever, just assuming the office made a mistake. I've been in this a long time and I will never, ever not say the insurances don't make mistakes. They do, and when they make mistakes, they need to be held accountable, and not the doctor's office. So definitely check your benefits before you're seen by your provider.
Speaker 2:You have access to everything that us billers have access to, just in a different manner. You have a provider, we have a provider portal, you have a member portal. Everything in that provider portal matches whatever is in that member's portal, so you can see everything that we do at all times. That's something you should a client should really, you know, pay attention to. They should really log on to their provider portal at least at the end of every month, just like you go through your bills, and you pay your bills at the end of every month or you have certain dates set of time. Make sure that you're going through your claims, make sure everything's correct, because then that also helps providers. If the insurance makes a mistake, then they can let us know. We can get it fixed.
Speaker 1:That's so great. That answers my next question what resources or tools are available to help individuals really understand and make the most of their mental health insurance benefits? And I think you nailed it right on the head the provider portal. So, if so, I'm assuming the provider portal that's not something that is or sorry, not provider portal, member portal. I'm assuming that's not something that's provided by the physician or the therapist that you're seeing. That's where your insurance information lives, and the people who own that portal are the insurance companies. So then you would just need to go to your insurance company's website to log in and see that information Correct.
Speaker 2:Yes, yes, yep. You just have to log in, get a username and a password and you can see everything. Any of every provider or every pharmacy builds.
Speaker 1:Awesome. Okay, so I think we've gone through some pretty useful information here. I know I feel a little bit smarter. I would still probably call you if I got a little stuck in navigating my insurance. It's always helpful to have a friend who really understands it and has been doing it for a very long time. But in terms of utilizing insurance to cover mental health, I think the key takeaways we have are you can do it. You can choose whether you're going to look for an in-network person and know exactly what is going to be charged and your co-pay and your deductible, or you can go out of network, where it's more of a relationship and agreement between you and the provider.
Speaker 1:The insurance company doesn't really get involved contractually with the provider. Really making sure you are advocating for yourself and aware of your own insurance benefits so that there's less likelihood of mistakes, and also partner in with your provider and their billing office to stay up to date with changes that are going on with your insurance, in case you are entitled to a refund or something wasn't submitted or the insurance company made a mistake. Really just knowing that and knowing that everyone is human. It's not always the provider's fault, it's not always the insurance's fault. I think we've really unpacked a lot. Explanation of benefits very important piece of paper. You want to keep that for your record purposes. Thinking of all that we've talked through, do you have any tips or additional advice for listeners who are currently using their health insurance for mental health care or considering on doing that?
Speaker 2:Yes, I do. First thing is know what you're signing up for. Know what benefit plan you're signing up for, when your job or you're on the marketplace. Really understand. If you don't understand, go to a friend that understands it. Call the insurance company and have them explain it to you. I'm pretty sure there are also people selling the insurance so you can call them. Understand what you're signing up for, because once you sign up for it you can't go backwards for many, many months. You're stuck with this insurance plan. Know what you're signing up for. I've even had my own family member sign up for something and I'm like why didn't you come to me first? Now you signed up for the worst plan on earth and you're upset because you're getting tons of bills because you're not paying any premium. That means that on the back end you're going to get charged for everything.
Speaker 2:Know what you're signing up for. Make sure you know your benefits once you do. Make sure you know what kind of clinician that you're meeting with, what kind of doctor you're meeting with what, how the whole billing process works. Don't never be afraid to call the office and ask to speak to the billing office. They should really be available to you at least within 24 hours of your call. Ask questions. Don't be afraid to ask any billing questions to the insurance company as well as your provider's office. Everybody should be there to help you.
Speaker 1:That's such a great call out and I can speak for all of our team here at Kindermine and Michelle, who is our billing and insurance guru. We and she are always happy to be here and answer your questions and explain the information that we've received when we checked your benefits. But again, super important that you also reach out to your insurance, verify that that's also what you're hearing from your insurance, so that everyone's on the same page. But absolutely that is something that we value at Kindermine is being here to support clients, making it possible to use your insurance, so that you're not having to be the one to figure that out and really support clients on that insurance billing in. So then, all you really have to focus on is therapy and your mental health journey. That is correct. Well, thank you so much for joining us today, michelle. It was so great to see you and talk to you and go through all of these questions that I know we're super helpful for folks to get the answers to.
Speaker 2:Yes, thank you, thank you for having me, absolutely.
Speaker 1:The Kindermine podcast is produced by Dr Elizabeth Barlow, edited by Marco. Antonio with music by Pax Minerva. Thanks,