New laws which may affect your mental health insurance have gone into effect January 1, 2010.

A new law, The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, went into effect January 1, 2010.  In simple terms this law says that your mental health insurance coverage has to be equal to your medical insurance coverage – if you work for a company with 50 or more employees.  If you had a heart condition the insurance company could not say, “We’ll pay for 10 visits to a cardiologist and we’ll only pay for 15 days in the hospital.”  Therefore, in theory, the insurance company is not supposed to limit the number of sessions with your therapist, nor put limits on inpatient hospitalizations. 

Your medical insurance and your mental health insurance are two different insurance policies.  Just because you have “good medical insurance” does not mean that your mental health insurance coverage is the same.  You may find that the insurance company that covers your medical claims is not the same company which covers your mental health claims.  Your mental health insurance may have to be pre-certified or pre-authorized.  If you do not get the sessions pre-authorized, your mental health insurance company can deny all claims and pay NOTHING for up to a year! 

Another common “surprise” is that your insurance company will pay for six sessions without pre-authorization, and then require pre-authorization for future sessions.  Future sessions can be then denied because they were not preauthorized.  

Some insurance companies will pay for medical nutrition counseling.  We recommend that you call your insurance company and ask.  You may need to get a “prescription” from your medical doctor in order for your insurance company to justify the need for these services. 

All of the therapists at The Awakening Center are in network with BCBS of IL PPO.  Some therapists are also in network with Aetna, Cigna, Humana, Magellan & Unicare.  Even if we are not in network with your insurance company, we can submit the claim to your insurance company directly or give you a receipt which you can send to your insurance company for reimbursement. 

The therapists at The Awakening Center all have a limited number of sliding fee appointments.  We offer very-low-fee therapy with therapists-in-training for clients who do not have mental health insurance.  Please be aware there may be a waiting list for very-low-fee therapy.  We are sorry but we cannot accept Medicare or Medicaid.  

We cannot tell you what your insurance coverage is – as each policy is different, even within the same company.  We recommend you call your insurance company directly to verify your mental health insurance coverage before you begin therapy.  This will eliminate any “surprises” which may interfere with your therapy later on. 

It is very important that you call your insurance company to verify your mental health insurance benefits.  This must be done before your first session with your therapist.  The phone number is usually on the back of your insurance card.  If you have any problems calling your insurance company, please feel free to talk with your new therapist. 

Here are some suggested questions you may want to ask your insurance company about your mental health coverage.  There is usually an 800 number on the back of your insurance card.  We recommend that you print out this page and fill it out as you speak with the insurance company.  Please make a copy of the answers for your therapist at your first session.

Name of insurance company:

Insurance phone number:

Date of call to insurance company:

IMPORTANT: Name of person you spoke with:

Say: “I would like to verify my insurance coverage for outpatient mental health services.  Is my mental health insurance coverage the same company as (name of medical insurance company)?”

Is (Therapist name or The Awakening Center) an ‘in network provider’?

What is my deductible?

Have I met my deductible?

What percentage will you pay for each session?

Is there a maximum number of sessions per calendar year?

Is there a maximum amount of benefit payments per calendar year?

Is there a pre-existing condition clause?  What conditions are in the clause?

Will you cover CPT code 90808?

Do the sessions need to be pre-authorized or pre-certified?

What is the procedure for pre-authorization?

What is the address to send claims?