FREQUENTLY ASKED QUESTIONS

If you are currently employed and/or enrolled in a private insurance plan such as Empire Blue Cross Blue Shield, Oxford, Aetna, Cigna, GHI, and others, you do have mental health benefits to help pay for an evaluation or treatment in an office or a clinic setting.

In Network Benefits:

Your private insurance plan has a mental health in-network benefit if you see an in-network provider. In network providers are those mental health professionals who have made an agreement with the insurance company about what fees to charge you. To find out who your In-Network providers are, call your insurance company and request a list of providers in your area.

Pros:

– Low co-pay, usually between $10- $50, depending on the insurance plan.
– No need to negotiate fees with in-network provider.

Cons:
– In New York, many available mental health providers are not in-network and you have fewer options if you only look into in-network providers.

Out of Network Benefits:

Your private insurance plan may have a mental health out-of-network benefit.

In this case, the mental health provider does not have a contractual agreement with your insurance provider. You are responsible to pay the fees charged by the mental health provider.

Your insurance provider may offer to reimburse you a percentage of the costs if you submit appropriate bills and claims paperwork.

In order to utilize out-of-network benefits, contact your insurance provider and inquire what the benefit is. They may authorize you initially for a certain number of visits. They may reimburse between 50% – 80% of the cost of the visit (as long as the fee charged to you is “reasonable and customary”) but they may also require you spend your own money until you reach a deductible amount. They will inform you of the claim paperwork that needs to be submitted. Your mental health provider may need to complete treatment plans and updates in order for the insurer to authorize more visits.

Pros:

– If you have the cash flow to pay up front charges to your mental health provider, the reimbursement can decrease your final cost per visit significantly.
– You have the flexibility to choose a mental health provider who is out of network.
– You may still negotiate fees with your mental health provider, if they offer a sliding scale.

Cons:

– Out of pocket costs are greater than with in-network providers.
– You are resposubmit apprnsible to opriate paperwork to your insurance plan in a timely manner.

If you are currently insured with Medicaid or one of the Medicaid Managed Care Plans, you do you have mental health benefits.
In order to identify mental health providers who accept your insurance, you will need to call your insurance plan and request the names of accepting providers or clinics in your area.

Most public and private hospital based clinics accept public insurance but you need to confirm that your specific managed care plan is accepted.

Pros:
– No or very little “out of pocket” costs. Many available clinic or hospital based providers throughout the city.

Cons:
– Wait time for initial appointment may be longer.

If you are currently covered with Medicare, you do have mental health benefits for outpatient mental health treatment in an office setting, clinic, or hospital outpatient setting. The services must be provided by a medical doctor, clinical social worker, psychologist, nurse practitioner, clinical nurse specialist, or physician assistant.
The mental health services must delivered by a health care provider who accepts Medicare payments.

If you are currently uninsured, not covered for mental health services, or do not desire to use your insurance for mental health treatment, you can opt to pay “out of pocket” for your treatment. Some patients also have family members assist in covering the cost of their treatment.
Many providers and clinic settings offer sliding scale fees. A “sliding scale fee” means that you will pay a lower fee for treatment based on your income. You should always inquire about whether a provider has a sliding scale if you are interested in this.

Pros:

– Flexibility with choosing a provider,

Cons:

– Higher “out of pocket” costs.

Mental health treatment is available throughout NYC and is accessible to you. Although the payment structure, wait times, and the treatment settings do vary based on your resources, it is important to not get discouraged. Seek treatment if you need it.

References: www.medicare.gov

Individual Therapy

This therapy involves meeting one-on-one, the patient and the therapist. The goal of individual therapy is to help an individual to learn more about themselves, gain new perspectives, identify strengths, as well as recognize and change destructive behavior patterns. Working with a licensed psychotherapist is the most effective method of overcoming chronic depression, fears, trauma, anxiety, and breaking unhealthy patterns. Unlike friends and family members who are too personally involved in our lives to challenge our mode of operation, an individual therapist is a trained professional who will lend objective support, help a person to discover new resolutions and assist in exploring solutions in different ways. In other words, individual therapy can help a person to become their best self.

Couples Therapy

This therapy helps couples to identify issues within their relationship that need work, with the goal of adjusting the behavior of both partners in order for each of them to feel a greater sense of satisfaction with the relationship. Couples therapy can be useful to partners who are seeking repair for a relationship that is in a rut or has been troubled by neglect, infidelity, or lack of appreciation. It can also be helpful for couples that are in pursuit of a healthier, more satisfying relationship. The therapy frequently involves enhancing couples communication techniques, which often includes the “the art of fair fighting” and “how to listen more effectively.” It usually involves helping couples to learn how to share responsibilities within their relationship and how to avoid negative competition with each other. When boredom, disconnection and/or hostility enter a relationship, the loss of companionship is extremely painful. The goal is to help couples to learn how to identify their own escape pattern which can include: affairs, excessive work, shopping, Internet, sports, hobbies etc. The aim of is to help couples to create a new sense of trust, connection, and passion.

Group Therapy

In this therapy, a therapist works with three or more people at the same time. Group therapy can be used alone, but it is frequently used in conjunction with individual therapy. Patients are able to share experiences and work to improve their way of relating to others within the group — and ultimately, in their own lives. A major advantage of the group therapy experience is validation. The group allows members struggling with the same or similar problems to see that they are not alone in their struggles. Another benefit is that patients are able to learn from the experiences of others and will be exposed to different perspectives on their problems that they may have never considered. Additionally, members are able to practice new skills (e.g., communication skills) before using them in their lives outside of the group. Group therapy can be especially helpful to people who are having difficulty with communication skills, relationship issues, substance problems, PTSD, or impulsive behaviors.

Family Therapy

This therapy involves an entire family, or several family members, all meeting with a therapist. Family therapy can be beneficial if a family is having consistent conflict, weak communication skills, or lack of goodwill and collaboration. In many instances, the families’ problem may be focused on a child or an adolescent, but this is not always the case. Family therapists are able to help the family avoid focusing on a single family member and help the entire family interact in different ways. Family therapy can be especially helpful to a family when a child is acting out or an adolescent is suffering from an eating disorder, substance abuse, or poor school performance.

Psychodynamic Therapy

Psychodynamic therapy is based on the assumption that a person is having emotional problems because of unresolved, generally unconscious conflicts, often stemming from childhood. The goal of this type of therapy is for the patient to understand and cope better with these feelings by talking about the experiences. Psychodynamic therapy is administered over a period of three to six months, although it can last longer, even years.

Interpersonal Therapy

Interpersonal therapy focuses on the behaviors and interactions a patient has with family and friends. The primary goal of this therapy is to improve communication skills and increase self-esteem during a short period of time. It usually lasts three to six months and works well for depression caused by mourning, relationship conflicts, major life events, and social isolation.

Psychodynamic and Interpersonal therapies help patients resolve issues caused by: loss/grief, relationship conflicts, and role transitions (e.g., becoming a new mother or a caregiver).

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy helps people with psychological problems to identify and change inaccurate perceptions that they may have of themselves and the world around them. The therapist helps the patient establish new ways of thinking by directing attention to both the “wrong” and “right” assumptions they make about themselves and others.

Cognitive-behavioral therapy is recommended for:

• Those who think and behave in ways that trigger and perpetuate unproductive thoughts.
• Those who suffer from depression and/or anxiety disorders as the only treatment or, depending on the severity, in addition to treatment with medication.
• Those who refuse or are unable to take antidepressant medication.
• Those of all ages who have mental illness that causes suffering, disability, or interpersonal problems.