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Financial Access to Mental Health Services

It may sound strange to start an article on financial access to mental health care with the credentials that different mental health providers have, but that is where consumers need to start in choosing a mental health provider.

Below there is a list of mental health provider categories along with their credentials.

Psychiatrists

Psychiatrists are medical doctors so you will see the initials M.D. after their names. Perhaps partly because of how few psychiatrists there are, how busy they are, and how complicated some of the psychiatric medications are their time is primarily spent prescribing and monitoring medications that help people manage mental illnesses.

Psychiatrists generally don’t do therapy with people but they often work closely with the group of mental health providers known as therapists. Family physicians and internal medicine specialists also often prescribe psychiatric medications for people. Licensed medical doctors are able to bill insurance companies for the services they provide.

Clinical Psychologists

Clinical psychologists are people who have doctoral degrees but in Wisconsin they are not legally allowed to prescribe medication. The initials you will see after their names are PhD or PsyD.

Psychologists have special training in psychological testing. In addition to doing testing, psychologists often do therapy with clients. Licensed psychologists with a PhD or PsyD degree are able to bill insurance companies for the services they provide.

Mental Health Therapists

There are 3 primary groups of mental health therapists:

  • MSW (or sometimes MSSW) — a title standing for Masters degree in Social Work,
  • LPC — a title standing for Licensed Professional Counselor, or
  • MFT — a title standing for Masters degree in Marriage and Family Therapy.

All 3 of these groups of people have masters degrees from accredited universities and can be licensed to practice in the state where they work. They are able to bill insurance for their services.

They all do similar work, and that is primarily talking with clients and helping clients find ways in day-to-day life to manage their mental illness and in some cases find resolution to psychological problems.

There are other groups of people who provide services that are often beneficial in managing mental illness such as yoga instructors, massage therapists, or pastoral counselors, to name a few, but these practitioners are generally not able to bill insurance companies for their services.

Insurance

Now on to how insurance plans. There are 3 basic types of payment for mental health services.

Private insurance

Private insurance may be insurance people get through their employers or policies people buy privately through the insurance market place. Private insurance companies typically cover the services of medical doctors, psychologists, and mental health therapists but consumers have several things they need to check on before they start seeing any one of these providers.

    • Consumers need to be sure that the providers they want to see are “in network”. That means the providers are on the list of approved providers for a specific insurance plan. That information can often be obtained by making a phone call to a provider’s office and asking if a specific provider is included in the client’s insurance network.
    • Sometimes private insurance plans will pay something toward the charges for mental health providers who aren’t “in network” but at a lower rate than they will pay toward providers who are “in network”. In some cases they won’t pay anything toward providers who aren’t “in network”. Consumers can still see providers who aren’t “in network” but they must be aware they will be financially responsible for the services provided.
    • There may be client co-pays for people who pay for mental health services with private insurance.
    • People who have private insurance should check their policies to see what kind of mental health coverage their policies cover.

Medicare

Medicare is an insurance plan for people over age 65 and for younger people who have been deemed disabled for 2 years or for people with end stage kidney disease.

It is administered by the Social Security Administration. It isn’t free. People who have been employed pay Medicare taxes during the years they are employed and there is a premium that is subtracted from people’s monthly Social Security check for Medicare coverage.

Medicare is a very complicated program. Anyone who has questions about whether or not they might qualify for Medicare should contact the Social Security Administration. It is important to learn the procedures for getting on Social Security and gaining access to Medicare.

    • People who have access to the Internet can look at the Medicare.gov website and get answers to at least some of their questions.
    • It is also possible to make a phone call to the Social Security Administration. People who call the Social Security Administration should be prepared by having their Social Security number available to give over the phone, they should have their questions ready and any paperwork they need to talk about, and they should be prepared for quite long wait times before they are able to talk to a Social Security representative.
    • There is also a Social Security office in Wausau staffed with people who are part of the Social Security Administration. It is possible to meet with those people in person or to talk with them over the telephone. They have access to all of the Social Security Administration’s rules and regulations.
    • Medicare covers the services of psychiatrists and other medical doctors, clinical psychologists, and licensed clinical social workers but it does not cover the services of Licensed Professional Counselors or Licensed Marriage and Family Therapists. Consumers need to find out before scheduling an appointment if the mental health provider they want to see is a medical doctor, clinical psychologist, or licensed clinical social worker. Not checking out these things ahead of time may result in a big bill that will have to be paid out of pocket.
    • With Medicare there is usually a co-pay for outpatient medical services, including mental health services.

Medicaid

Medicaid is federally funded insurance for low income individuals who are over age 65 or blind or under age 65 with income below a certain amount depending on how many people there are in the family.

Like Medicare, Medicaid is a very complex program.

People who want to learn what they need to do to see if they qualify for Medicaid, can contact the Central Consortium at 1-888-445-1621. This is an office that handles Medicaid and FoodShare applications for Langlade, Marathon, Oneida, and Portage Counties.

Self-Insured / Private Payer

There are people who have no insurance. As with all uninsured people, any health care they receive is paid for on a fee for service basis.

People who don’t have insurance but who want to see a mental health provider are encouraged to call providers’ offices to learn if they offer a sliding fee scale based on income. Consumers should also ask questions about how the sliding fee scale works.

For example: Is there a lower limit to the sliding fee scale? How do people gain access to the sliding fee scale? What kind of documentation do they need to provide to prove they qualify for a sliding fee?

 

This article is an introduction to how to start getting access to mental health services. If you have questions about anything in this article, please contact us at NAMI Northwoods. We will try to answer your questions or steer you to people who can answer them.

By Delores Kessel, LCSW.  Ms. Kessel was on the advisory council of Community Corner Clubhouse and is a retired mental health provider living in Wausau.

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