It’s amazing just how vast, confusing, and ever-changing the modern world of insurance is. I’ve had several new clients make assumptions about various aspects of this process as it relates to counseling and I thought this might be a good time to write a reference guide in support of making it easier and clearer on all of us!
The first thing to know about insurance providers is that, while most operate within the same structures and framework, they all differentiate somehow. Yes, sometimes this is maddening, sometimes it’s actually convenient, and a good rule of thumb is to get the information about your particular eligibility directly from them. Don’t assume your benefits are the same as your friend who has the same provider. All of the major providers (Moda, Providence, BCBS/Regence, Kaiser, Cigna, Aetna, Pacific Source, etc.) have a multitude of different plans to offer. Some even have plans within plans! So…
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- Call your provider. Don’t assume you have benefits then end up owing a counselor out of pocket!
- Ask potential counselors what panels they are on. Unlike most physicians, many of us are not paneled too broadly. Sure, some people are, but many panels are closed to new licensees and many of us choose just a select few panels for a variety of reasons.
- Out-of-network. Even if you really like a counselor who is not paneled with your provider, it is possible – even probable for many – that you may be eligible for reimbursement for services rendered out of your network. Ask your counselor how this process works, as we tend to vary in preference. I offer direct claim submission for my out-of-network clients as long as they (1) check with their insurance provider and (2) decide that the benefits are worth claim submission (not all out-of-network plans are).
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