Understanding Insurance
Most people have insurance, but they do not understand how to use their benefits. Most people either have a commercial plan or a government plan. A commercial insurance plan is a plan that a person gets from their employer. A government plan is a plan that is provided by the government such as Medicare and Medicaid. There are two main types of commercial plans. The first type of plan is a traditional plan. Traditional plans include copays. When a person sees the doctor, the person pays a copay. The purpose of having a copay is to help the cost of services to be more affordable to the patient. For an example, the therapist has a contracted rate of $110. A person with a traditional insurance plan has a co-pay of $40. The therapist will get $40 from the patient and then the therapist will get reimbursed the remaining amount by the insurance company.
The second type of commercial insurance plan is a high deductible plan. When someone has a high deductible plan, the individual will have a deductible to meet before the insurance will provide any coverage. Most deductibles are around $3000. This means that the individual must pay $3000 out of pocket before the insurance company will provide any coverage. Once when the deductible is met then the individual is responsible for paying their coinsurance. The coinsurance is a percentage of the contracted rate that the provider has with the insurance company. Many individuals have a coinsurance of 20 percent. For an example, an individual sees a therapist and the therapist has a contracted rate with the insurance company for $110.00 per a session. The individual will be responsible to pay $110 per a session until the deductible is met. Once when the deductible is met then the individual will be responsible to pay 20% of the contracted rate or $22.00 per a session.
Government insurances such as Medicare and Medicaid. There are many different Medicare plans and Medicaid plans. We are out of network with most Medicare plans. If we are out of network with your plan, we do have providers that can see you on a sliding scale. The Medicaid plans regarding mental health are managed by Behavioral Health Care Managed Care Organizations (BH-MCO). People with Medicaid are assigned a BH-MCO based upon their county of residence. Providers are assigned to a BH-MCO based upon their practice location. Some BH-MCOs contract with individual providers while others will only contract with facilities like CHOP or Penn Medicine. Eagles Counseling is not in-network with any BH-MCO plans. We do accept some Medicaid waivers such as VCAP and ACAP.
Another type of insurance that helps cover the cost of therapy is an EAP or Employer Assistance Program. The is not insurance but a benefit that is offered at many jobs. EAP program providers a person with an authorization to see a therapist for free for a certain number of sessions.
Other types of insurance that may cover the cost of therapy are Workers Compensation and Auto Insurance. Sometimes these types of insurances might cover the cost of therapy when someone was hurt on the job or in a car accident.
After reading this you might be wondering how someone can afford therapy if their therapist does not take their insurance or if they can’t afford to pay the full cost of therapy. Eagles Counseling does offer a sliding scale to people that cannot afford to pay for therapy. We do hire therapists that are in training that can see people at a lower fee. We also do partner with non-profits, youth centers, and churches. Some of our patients have been able to get their therapy paid for by a charity organization. We will write a letter to an organization to help cover the cost of therapy.