Hi Starfishy,

When you say done privately, do you mean that you just pay the therapists fee yourself? Whatever their fee is?

The insurance situation is kind of confusing. My T bills my insurance company $180.00 a session. But they pay him $55.00 and I pay him $30.00. If I didn't have insurance, he might actually charge me anywhere from $65.00 a session to $120.00 a session.

So, I could still see him as long as I could afford to pay.

A lot of insurance plans will limit the number of sessions they will pay for to say, 30 a year and that doesn't even cover once a week for a year. But they will supposedly cover unlimited sessions if you have a biologically based disorder. Although my insurance company turned me down for that last year so they are not always fair and honest.

The bottom line is you can always go to therapy even without insurance as long as you can afford the fees. We do also have nonprofit organizations with therapists who do therapy for a low fee or nothing if you qualify. Those therapists don't get paid much and also burnout quickly from high caseloads.

The colleges I went to all had free counseling. They staff those centers with students working on their graduate psychology degrees.

Does that help?

Thanks Liese, it does. Does the amount of sessions you can have then also depend on how much you pay in or how severe your need is? Does everybody have to have some sort of private insurance?

Yes, privately here means that you pay the whole fee and that depends on the therapists experience and qualifications. You can get some free counselling on the NHS through your family doctor but that is usually limited to 6-20 sessions only for short-term help. You can get referred on the NHS to psychologists and psychiatrists, but the help can be varied depending on where you live and what is offered in your locality. Here for me there would be nothing.

Thanks for that info,it's made things a bit clearer

starfishy

Hi Starfishy,

The limitations are "only" financial. If you can afford to pay for sessions, you can have as many as you want. Many people here do not have insurance and so have to either go to a free clinic or do without if they can't afford to pay the private fees.

My new plan allows for unlimited visits for biologically based disorders which includes depression and anxiety. I'm supposed to have an unlimited number of sessions but I'm waiting to see if the insurance company is going to put up a fight at some point.

Right now, I'm going twice a week. That means that I've gone to approximately 24 sessions since the beginning of the year. Since it's a new insurance policy for me, I don't know when and/or if the insurance company will try to put their foot down and tell me they won't pay for anymore sessions.

If they refuse to pay for my sessions at some point, I can always pay my T out of pocket. Last year, when I ran out of sessions, he was charging me $65.00 a session. At some point if I go back to once a week, I could probably handle that on my own if that's what he was to charge me again.

Are the private fees high there?

My insurance allows a maximum of 30 visits per year with no exceptions even if it's biologically based. I have a co-pay of $30. if I need more than 30 visits, my current T charges $90, which is a reduction from her original $150 fee. Because she is dropping my insurance (most people who have insurance get it through work and only pay a portion of the monthly cost - it can be very expensive to buy your own insurance plan), I can stay with her if I choose, but then have to pay the $90 for all sessions. I've been looking at individual plans here in the US and most are around $300/month and only a small percentage of them even offer mental health care. The ones that do limit sessions 20-30 visits. Liese, that's great yours will not put a maximum on yours, as long as they don't try to fight it!

((((RAVEN))))

My old insurance contract included unlimited visits in it for biologically based disorders but when I asked for them, they fought it and I lost.


I got rid of that plan because I was so mad. My H is self-employed so I have the option of switching insurance companies when I want to.

My new plan's contract didn't include unlimited visits but I could pay extra for a rider to my contract. I did that and wondered if that alone would make the difference, just the fact that I paid extra for the unlimited visits. It really wasn't a lot of money, maybe like $25.00 a month extra. Well worth it.

But I wasn't sure if they too would give me a hard time about it and exactly what do they mean by unlimited visits? It's clear to me what unlimited visits means but it was clear to me that I should have had unlimited visits under my old plan too and that wasn't the insurance company's version.

When T's secretary called to confirm my coverage after the change of insurance companies, they told her that I do indeed have unlimited coverage simply because I purchased that rider. We'll see as time goes on what that really means.

Aww Raven, that's tough, so you end up paying twice really

Leise, I am glad that the rider worked so well for you, gosh it seems quite a hit and miss system, I hope it continues for you in that unlimited really is unlimited.

Fees here, well it's hard to say because I only know my area and guess some places might be more or less expensive. Counsellors here charge between £30-£60/hour, clinical psychologists 3 times that much, other therapists probably somewhere in between. Whatever it is, it mounts up

starfishy

Oh geez, Starfishy, that does add up. My T is a clinical psychologist but because of the way our health care system works here, the insurance companies have all the control over the fees. The doctors feel compelled to enter into these contracts with the different insurance companies, who set their fees. For instance, my T can't change the rates. He can't charge me more than $30.00 (he can't waive the fee either) and he won't get more than $55.00 from the insurance company unless there is an across the board rate change.

The doctors don't HAVE to enter into these contracts with the insurance companies but it's much harder for them then to build up a practice. We get lists with the names of participating doctors on it and choose one according to our list. Hopefully there will be someone we like on the list. I've never had a problem finding a good doctor from my lists.

But if a doctor isn't on the list, the likelihood is low that I or anyone else would choose them unless I had a special need. Sometimes when a doctor builds up a big practice and/or a huge reputation, they might opt to not contract with the insurance companies and that way, they get to set their own fees.

Needless to say, the doctors are not very happy about this setup. They want to set their own fees but are strong-armed by the insurance companies.

quote:

Oh geez, Starfishy, that does add up.

Best not to think about it eh?

Gosh how complicated, I can see why the Insurance Companies have such control, also must be quite hard for new therapists with not such a great reputation to star up and get accepted.

starfishy

I came from a country where I did not need my own health insurance... i think nobody understood at employee orientation when I started to cry because I couldn't place a value on my health, or on the health of others, or how much it would cost.

The system works by charging paying part of my T bill and I pay the rest. My T has to submit paperwork so my insurance knows stuff I've told my T if they are in her progress books and about my condition. If I lose my job I lose my insurance or pay 100's more than I do through work (which the price doubles every year at my company). If my coverage lapses (i.e.: I do not hold some sort of coverage between jobs, etc which is why I can't quit the hellhole I'm in) I have to look for cheap coverage that will cover nothing but emergencies otherwise when I go back to having insurance coverage what I had before is a "pre-existing condition" and I didn't receive "continual coverage" so I may have to wait month, if ever for my PTSD to be covered at a later time. They can take away paying for things, it's terrifying as someone who grew up in a place where I couldn't conceive of this - but also didn't have to deal with being an adult there. Mental health still needed to be covered privately, same with eye care but many companies offered supplemental insurance. If you're married here it works a little better because if you lose coverage, you can get switch to your spouse, etc.

I make it sound probably worse than it is... but that's how I experience it and I live in continual fear and anxiety. I feel trapped in a job I hate because I desperately need my therapy. Many companies will make you wait a few months (3 or whatever) before you are eligible for their insurance plan - my company will make people wait up to 23 months because of a rule they have that you must be employed for 12 months before you can get on the "good" (non-catastrophic emergency) coverage plan when insurance enrollment comes. So let's say you were hired in January... oops poor you because by december it will only be 11 months of work therefore you don't get to enroll and cannot enroll in the middle of the year so you wait until next year. I have pretty good insurance and this year have not been able to afford an x-ray I need yet because of my deductible

((((((Cat))))) that's one tough situation.

quote:

I have pretty good insurance and this year have not been able to afford an x-ray I need yet because of my deductible

I can't believe in this day and age that could happen, our NHS system has its problems but it does mean everybody can have free health care for the basics at least.

starfishy

cat x

fishy

I have insurance through my H's work, a pretty decent HMO plan. We pay somewhere around $350 a month for it, and it includes physical/behavioral health, but not dental, life, etc. Which are separate fees. The company pays the other portion of the monthly cost, I guess. If my H lost his job, it would cost us at least $800 privately, I think. I happen to have no deductible on my HMO. Physicians visits cost me $20 copay each time, prescription medications usually about $15, behavioral/mental health visits $30. The in-network doctors are limited, but it so happens I have a great GP for primary care. If I need a specialist, I have to go through her and get referred. We pay extra for xrays and certain labs. ER visits are $50 and if they can "prove" it wasn't an emergency, they can refuse to pay (tried doing that to me once).

My mental health visits are unlimited, but only one of the same type of service on any given day. Meaning, I might be able to see a psychiatrist for meds and my T on the same day, but not two Ts. My T was out of netwrk, so we were paying him $125 a session for the first couple of years my H and then I saw him. I actually didn't know we had mental health coverage, because H made a mistake. T usually charges $150, but he has a huge sliding scale down to practically nothing when he feels called to offer that.

Last Summer, when I found out my insurance covers mental health, I asked T to apply for a single case agreement, because my insurance didn't have any other Ts that had experience w my stuff, or at least that I had success getting a hold of, and I was already attached to T. The process took a couple of months, they fought to reject me, but ultimately agrees w T's assessment that I should stay w him. They regulate/decide how long our sessions can be billed for, how often we can meet, how much T makes, etc. I pay $30 each session. They pay T $70 for one hour with my H and $95 for 75 minutes w me. T extends the sessions to two hours for free. T has to fill out tons of paperwork, which I sign, to get reimbursed. He can only get approvals for about 15 sessions at a time, at most, sometimes less. He has to use up all our sessions, bill for them (organization is not his strong point), then call, discuss my case/progress, and request more, wait for approval. So, sometimes we are working not knowing for sure they will be covered and we're at their mercy if they get fed up...though, I think as he has managed to keep me out of hospitalization and expensive day programs, they see the value in approving our continued work. Much cheaper for them. If they stopped approving, I would have to accept T's grace to make even less when he is already being short changed (all the PhD MFTs out here seem to charge $150) or quit until my H's open enrollment allowed us to change to a new plan (which would mean higher monthly payment, higher session payment, deductible, but not at their mercy for approval).

So far, though, T says he is surprised by how well the company is working with us, except the administrative complications of the approval process. So, I'm crossing my fingers that is because I am making a lot of progress at this level of care.

My insurance plan does not cover mental health, meaning I would have to pay 100% of the bill of a psychologist or social worker.
In this area psychologists charge between $140-$180/hr and social workers offering T somewhat in line of $120-$150/hr.

Some (not all) offer sliding scale fees, meaning if you are very poor they offer you a discount. However not many people qualify for the discount. Our income is decent but with all the monthly costs that cannot be avoided (housing, insurance, groceries, kids' needs etc.) we hardly break even, we don't even have a car. But that is not taken into consideration. I wouldn't even be able to pay for 1 session a month without having to borrow money.

Fortunately, I was able to get counseling via a NPO who offers free T. There are plenty of drawbacks to that solution but it is much better than nothing. It might not be the best care out there but I am very lucky I get some support.

Ok well this is my predicament....
I'm an immigrant (I don't live in the States, Canada, the UK or even Europe) I live almost at the end of the earth. Where I live the government does fund therapy, but only if the events happened in this country. Mine did not. I am a permanent resident, but that counts for nothing. Meaning that in order for me to get therapy I need to pay for it privately at a cost of $140-$180 on average and higher per hour. Clearly I do not have that sort of money. I was going to an alternative health practitioner which I suppose I used as a therapist. That was $80 per hour, so I saw her once or twice a month. I know she was not qualified, but I needed someone to listen if nothing else. Now I have nobody. I have psych cafe, which I appreciate but it's not the same as being able to just sit and talk and have somebody really hug you. My friends and family don't really know - only 2 have an idea - so I bottle it up inside and pretend to cope with life.

Hi BTW

What a hard predicament for you, and how tough to only allow free treatment to those that had their events occur in that one country. I am so sorry and can see exactly why you would pay to have someone listen, qualified or not

I am glad that you can get some support from the forum here, I know this isn't the same as a real life hug, but winging one over to wherever you are

starfishy