Will Insurance Cover Grief Counseling?

Will Insurance Cover Grief Counseling?

What you should know about grief counseling and health insurance

Grief, while a normal part of the life cycle, can feel anything but ordinary. The reason we grieve is to emotionally release the attachment that we felt to another being and to begin the job of figuring out life without that person in it. The path of a person’s grief varies, and eventually time becomes the ultimate healer for many people.

Why might a person need to go to therapy if grief is normal?

For some, the strong emotions that go along with grief can be overwhelming and can cause a person to become stuck in the grief. Another possibility is that the event that caused the grief was sudden and traumatic, which can lead to feelings of uncertainty about things that once felt certain. Additionally, if a person has never experienced deep loss, grief is a new experience where guidance might be necessary.

Does my insurance have to cover mental health services?

For any company that needs to comply with the Affordable Care Act (companies with 50 or more employees must comply), if it provides mental health coverage, it has to be on par with its physical health coverage, according to the federal parity law. However, as always, there are some loopholes. A company can choose not to cover mental health as part of its insurance package. Talking to a human resources representative might clarify what’s covered. Most state and federal programs cover mental health. Individual plans are allowed to exclude particular mental or physical health diagnoses, so check your specific plan.

Will insurance cover mental health treatment for grief?

To cover the cost, most commercial and state insurance plans need two pieces of information to justify any health-care-related service, including mental health services: a Current Procedural Terminology (CPT) code and a diagnosis code. Although bereavement is normal, it does not meet diagnostic criteria as a disease. However, there are accurate justifying diagnosis codes that will allow the treatment to be covered.

How do I know if services are covered?

Start by finding out if the counseling provider you’re interested in is in or out of your insurance network. If the provider is in-network, services will be covered based on your contract with your insurance provider for mental health. For out-of-network providers, you need to pay for services up front; then, if your insurance provides out-of-network benefits, you can submit for reimbursement.

How much is covered for an out-of-network provider?

Call your insurance provider first and ask about mental health coverage for an out-of-network therapist. Be prepared to get incomplete answers or the runaround. Some therapists have scripts you can use to ensure that you get the most comprehensive answers from your insurance provider prior to setting up an appointment. If services are covered, it is typically a percentage. But before settling for an 80% reimbursement promise, ask about your deductible and what your insurance provider’s “usual and customary rate” is for an in-network provider. Often the reimbursement rate differs vastly from the rate your clinician might set. An example: Your plan will reimburse you 80% once you meet the deductible, and your clinician charges $100 per session. However, the in-network rate (or usual and customary rate) for that CPT code is $50. In this scenario, you can assume that you will get 80% of $50 back (or $40), even though you paid $100 for the session.

Image via Shutterstock.com

Dr. Julie Bindeman is the codirector of Integrative Therapy of Greater Washington and works with issues around grief and life transitions.

Please feel free to contact us with any comments or questions.

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