Understanding Your Mental Health Insurance
Benefits and Planning for Payment
It is important to understand your payment options for counseling and psychological services prior to your first session at Bethlehem Counseling Associates. The following information should assist you in determining the method you would prefer to use for payment.
Standard Fees in Direct Payment Plans (Self-Pay)
The standard fees for services at Bethlehem Counseling Associates are as follows:
Clinical Social Worker
BCA Clinicians are members of most insurance panels and partner with approximately 75 to 100 different groups who offer funding for mental health services. Our Administrative staff will verify whether or not we partner with your insurance plan at the time of your first call. BCA participates with the following major insurance companies:
- Capital Blue Cross
- Highmark Blue Shield
- Medicare (Novitas)
- Personal Choice/IBC
- United Behavioral Health
- United Medical Resources
- Value Options
When you call BCA for your phone intake interview, the office staff will ask you for your insurance information. Once it is determined that your insurance plan covers mental health treatment and BCA is a participating provider, an appointment will be established. BCA staff will not schedule an appointment until it is determined that you have appropriate insurance coverage or you agree to pay without utilizing your insurance.
Our goal at BCA is to ensure that our clients receive high-quality mental health care. We realize that “affordability” is a real issue for most of us. We hope the information helps you better understand insurance and the funding options available to you.
Three Basic Types of Insurance Plans for Mental Health Benefits
In planning for payment you should first determine which of the three basic types of insurance plans you currently have. Many of the questions you have will be answered by determining the type of plan you have and verifying your mental health benefit with the Employee Benefits Manager at your workplace or making direct contact with the insurance plan’s Customer Service Representative.
Indemnity plans allow for the insurance payment to go directly to the client or the responsible party for the client. Consequently, the client or responsible party pays in full for the mental health services that are received. The provider of the services provides a receipt that can be submitted to the insurance plan, the client or responsible party then submits the receipt and receives reimbursement from the insurer. With Indemnity Plans there is often a deductible amount that must be paid by the client or responsible party before reimbursement is offered. Indemnity Plans reimburse on Standard Fee for services, allow clients to choose their own counselor, and allow the counselor to determine how many sessions are necessary.
Preferred Provider Organizations (PPO)
PPO plans establish contracts with a group of counselors who are noted as “in-network providers.” The contracts set the fees that in-network providers are allowed to bill. The fees are only paid to the provider and cannot be paid to the client or responsible party. The cost to the client or responsible party may include a deductible and/or co-pay. If the client or responsible party selects an out-of-network provider, the plan may be the same as an Indemnity Plan.
Health Maintenance Organizations
HMO plans operate in a similar manner to PPO plans, however, HMO plans have three unique characteristics. First, HMO plans require that all mental health services are precerted by the primary care physician (PCP). Second, HMO plans require that the in-network counselor submit treatment plans to a designated person at the insurance company. The person at the insurance company then determines the necessity for services based on the treatment plans. Third, there is no benefit provided to the client or responsible party if an out-of-network counselor is selected. Like PPO plans, HMO contracts set the fees for in-network providers and the fees are only paid to the provider of services. These plans seldom have a deductible but often require a co-pay. HMO plans generally have lower premiums then Indemnity and PPO plans.
Reduced Fee Payment Plan
If you cannot afford the standard fees at BCA, and you are ineligible for insurance reimbursement, you may inquire about a reduced fee for mental health treatment. Each individual Clinician determines whether or not they allow clients to pay a reduced fee, and what fee is acceptable for their services.