The movement of destigmatizing mental health services has impacted people of different races, ethnic groups, nationalities, backgrounds, and genders. The rate at which people can find and engage in services is moving at a different pace. Most people of color do not have access to affordable health care. Many have created the mindset of having a good career,
maintaining financial stability, and having insurance. Two out of three of those are not bad, but what some people know about insurance is lacking.
People are often exposed to information related to their health insurance policy by a person working in a human resource department. To maintain financial stability, people choose to enroll in the cheapest insurance plan which sounds reasonable, but that is not always the case. Lower insurance premiums can mean a higher deductible. The deductible is the amount that must be filed for claims that the insured will owe for services. Once that amount has been submitted to the insurance company, they can reimburse the provider for services moving forward. The deductible is not part of the copay and typically restarts at the beginning of each year.
If a person has a $2000 deductible, they must go to a health care provider and engage in $2000 worth of services that are to be billed to the insurance company, then denied payment, and the insured will owe the health care provider directly. The benefit of having insurance is that they have a fixed rate for services with health care providers. So, that rate is what the insured will be billed and is responsible for. This includes behavioral/mental health services which can go towards the deductible but is also different from and in addition to the co-pay fee.
Some plans have different options for mental health services referred to as behavioral health services. Most insurance companies have a list of behavioral health providers in their network. A few will contact behavioral/mental health providers to see if they have availability and let their members know. The math part is in the writing.
The average cost for monthly insurance premiums can be around 400-500 a month. Deductibles can be from $0-6000 a year. The average for a single individual can be from $2500-5000 and for a family $8000-10,000 per year. The average amount insurance companies are willing to pay for behavioral health services is about $70-115 per 55-minute session. Here are some examples of this.
If Alan has a premium of $500 a month, a $20 copay, and a $750 deductible then Alan may meet the deductible in a few months and still have a copay for each visit.
If Brenda has a premium of $400 a month with a $2500 deductible and a 20% co-pay, then Brenda may not reach the deductible for a few months, still have to pay her premium, co-pay, and owe the provider for services until the deductible has been met.
If Chris has a premium of $600 a month with a $1200 deductible with a $10 co-pay but the deductible does not apply to behavioral health services, then Chris only pays the co-pay for behavioral health services, and the deductible applies to medical claims.
If Dorothy has a premium of $550 a month with a $2000 deductible but has full coverage for behavioral health and no co-pay, then the plan will cover services.
Sometimes less cost upfront does not mean it is the most reasonable. Money can be a huge factor when people are using mental health services. While, many people may want the services, knowing about insurance coverage is something they do not consider, and changing plans or enrollments are usually based on a dateline. While coaching services may be more reasonable, that is a service that does not provide counseling, mental health assessments, or mental health diagnoses. Coaching services are not currently billable to most insurance companies and are an out-of-pocket expense. As beneficial as counseling and coaching can be, knowing about payment options before using the service can determine if, what, and how frequently a person accesses care.
Contributor:
Jamille J. Edwards is a counselor, educator, and author. Jamille is the owner of Golden Century Wellness. She provides counseling, coaching, and wellness services. She specializes in dual diagnosis and has experience working and addressing topics related to sexual trauma, trauma, substance abuse, crisis interventions, domestic violence, grief, parenting, multiculturalism, children/adolescents, family conflict, and neurodivergence. She uses an integrative approach to her work and enjoys helping people heal their mind, body, and soul. She can be reached at goldencenturywellness@gmail.com
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