When I signed up my kids for therapy after my divorce, I made some financial mistakes. The biggest was choosing an out-of-network provider, over one who takes my insurance.
Instead of a simple $20 co-pay, I spent $150 out of pocket and get 70 percent of it reimbursed, which works out to about $1,000 more over a school year. In contrast, I have a friend whose child’s therapy sessions require no co-pays at all.
In this way, mental health coverage has a lot in common with airline pricing, where seats on the same plane may sell at many different price points.
Overall, Americans spend about $2,100 per child for healthcare, according to the Health Care Cost Institute’s report for 2007-2010. During that period, HCCI says, the use of mental health services by children jumped 24 percent.
At the same time, nearly half of all psychiatrists no longer take insurance, according to JAMA Psychiatry, with a similar portion of psychologists now only accepting private payment.
Add to that an overall shortage of providers – there are 8,700 child and adolescent psychiatrists, compared to about 50,000 for adults, according to Dr. Paramjit Joshi, division chief of psychiatry and psychology at Children’s National Health System – and you have a supply and demand problem that makes cost a real issue for parents.
Finding a provider in your area may be easy enough, but finding one whose availability suits your child’s schedule could be downright impossible.
That’s why I went the private-pay route. My area of Brooklyn has no shortage of doctors on my plan, but after calling a dozen and finding that an after-school slot would entail a months-long wait, I went with a personal recommendation.
To avoid the appointment runaround, lean on your plan’s customer service department to make calls for you, says Dr. Ian Shaffer, executive medical director for behavioral health for Healthfirst, a New York health plan.
Need a therapist with a specialty? You may be able to get that provider covered if you ask, Shaffer says.
He cited a case where the family wanted a therapist who shared their ethnic heritage, and had been recommended someone who charged an eye-popping $350 a visit. Healthfirst found them another therapist with the same credentials, and covered the visits.
My friend with the zero co-pay has insurance through the state’s child health plan, but enrolment in the plan is possible only if you don’t have access to other coverage.
Most people who are on health plans through their workplace don’t have payment wiggle room, but you can ask individual providers what they can do to help, especially if you have a high deductible.
Many private-pay therapists have sliding scales based on income; others have lower fees if you work with a trainee. Since the latter are supervised grad students, “it’s like getting two doctors for the price of one, says Clair Mellenthin, director of child and adolescent services at Wasatch Family Therapy in Salt Lake City, Utah.
Also check state resources to help pay for therapy, especially if treatment is needed for some kind of trauma following a crime. Many states have victim funds, says Mellenthin.
Therapy can seem like an endless process, so parents need to make sure it’s staying on track, says Mitchell Prinstein, a professor of psychology at the University of North Carolina at Chapel Hill.
After the initial evaluation, make sure you have a clear treatment plan and markers to help you figure out if your child is making progress. If there’s little improvement, get a second opinion, Prinstein says. And don’t feel bad about moving on if the therapist is not the right fit.
Fight for your rights
For ongoing treatment, it’s important to make sure the insurance company is not crimping your coverage.
Even though parity clauses in the new healthcare laws say you should get as many sessions as you need, that’s not always the case.
After a while, insurers may start saying the sessions are no longer medically necessary. This is especially true if your child has a serious ongoing problem, says Alan Nessman, senior special counsel for the American Psychological Association.
Any denial of coverage can be costly.
Joe Hoyle’s bill for one month of his daughter’s treatment for a serious illness was $125,000 after his insurance company denied the claim (he negotiated a lower payment with the hospital directly). To obtain ongoing coverage, Hoyle and his wife, who live in Virginia, got her on Medicaid.
“They say they cover things, but then they get to decide when things are ‘stable,'” he says.
Hoyle urges parents to get care early for their children to try to head off bigger problems.
“You can go along for 10 or 12 years and think your kid is just quirky, then almost literally overnight, it can go to full-blown mental illness,” he says. “You hate to talk about it, but people need to know because state governments need to do more to help people out.”