Questions about Insurance, Fees, and Financial Hardship

We take most major insurances. However, each insurance pays providers different rates for the services they provide, which is rarely the full rate. Depending on the allowed rate, the provider has to write off portions of the fees for their services (sometimes more than 50%). Some insurances reject claims repeatedly, refuse to pay for services provided, or take excessive amounts of time to reimburse the provider (sometimes several months). Additionally, providers either handle billing on their own or pay someone for this service, so taking insurance actually costs them time and/or money just to be able to accept it at all. All of these reasons combined are why many providers are choosing not to take any insurance.  Because Courageous Counseling employs multiple therapists and values paying people enough to survive and thrive without a second job, taking some of the insurances would actually cause us to lose money (in other words, we have agreed to pay a higher hourly rate to our therapists than the non-accepted insurances will agree to pay us, which would cause us to lose money for every session provided at the insurance's steeply reduced rate). Another problem providers run into is that most insurance companies make it harder for small businesses to grow by offering higher contracted rates to larger businesses who have more providers. Not all businesses and therapists are paid the same rate, even though they are all required to have the same level of education, maintain a license, and have varying levels of experience. Some of the major factors insurances consider are the geographic location of the practice and the number of providers in the practice. 

Each clinician is allowed to decide whether to offer reduced rates, which is usually reserved for existing clients who have lost their job, insurance coverage, or other reasons that have created hardship. We may occasionally be able to offer reduced rates to a new client so it doesn't hurt to ask. If we are unable to accommodate the request, we have a list of places that offer free or sliding scale counseling on our website.  You can check out on our Resources page near the bottom under Free and Low-Cost Counseling. If you need counseling immediately and are interested in paying the self-pay rate, but you are struggling financially and want to delay payment or come up with an alternative payment plan, please contact us to discuss your options. 

Not all insurance companies' EAP programs are created equally, but in some cases, EAP is disguised as your employer paying for "free" sessions, while neither your employer or the insurance actually pay the provider the market rate for those services, or even the normal contracted rate that insurance reimburses for non-EAP appointments. The insurance company often requires that providers code these services as a significantly cheaper (but equally time consuming) service that they have contracted at a much lower rate. The rate is so low that Courageous Counseling would lose money to take EAP services in some cases since our therapists still have to be paid for those sessions and we do not agree with forcing our therapists to take a loss on session rates to help insurance companies make money or save large companies money on their group insurance plans. You have the choice to forgo using EAP credits and your sessions would be billed and reimbursed normally without the EAP code, or your therapist can voluntarily choose to accept it at the lower rate, but they will never be asked or required to do so by Courageous Counseling. 

It depends who you are insured with on whether you are struggling to find one or not. If you are saying, "Well that's not fair," you're not wrong and that's why we have decided to help educate people about how insurance works from the providers' end because there's a lot that consumers are unaware of when choosing plans. It's important information that absolutely affects you and your ability to find in-network providers when you need them. 

Here is a summary of all the ways your insurance carrier might affect your experience as a consumer (of any type of medical services): 

• Ability to get appointments in a timely manner.

• Choice in providers: if you struggle to find someone in-network, you will often find yourself just seeing anyone who will take you, while a person with a different carrier can actually choose someone based on their expertise, preferred demographics, location, etc. 

• Your health care costs: If you are paying high deductibles, copays, and/or co-insurance, plus a monthly premium just to have insurance to begin with, it's possible your insurance is putting more of the burden on you to pay for your healthcare costs than they are taking on. 

• Again, health care costs: If your carrier is one who rejects claims more often, you might receive unexpected bills for things that you and/or your provider thought would be covered, which shifts the expense onto you. You can call them and oppose their decision, but many people either take the loss and pay it out of pocket or they leave the provider at a 100% loss and just don't pay for the services, which discourages providers from continuing to accept that particular insurance, understandably. Most people will face financial hardship if forced to work for free and therapists are no exception. 

Since we are under contract with so many insurances and hence, are in a sort of partnership with terms and agreements, we can't really just rank them for you from best to worst. However, there are ways to know. They are as follows:

• Do you have a hard time finding in-network providers who are taking new patients when you need them? This is a common problem with HMO plans, as well as certain other popular carriers that are chosen by your employer because they are cheaper for your employer. They are able to give your employer a break on rates for several reasons: 

1. Certain insurances refuse to even offer group benefit plans to smaller businesses, so the companies getting those breaks are often large companies at least 50 employees.

2. As noted, they compensate by reimbursing providers at less than their market value, sometimes significantly less. 

3. They compensate by making you pay high deductibles, high co-pays and/or high co-insurance rates. 

4. They offer employees EAP sessions, which seems great as an employee, but as explained earlier, some of them pay significantly worse rates to the provider for services provided under EAP codes.

• When you receive an "explanation of benefits" after every visit to any medical professional, you can see on that statement how much the provider would typically charge for that service (usually under the column that says "charged" - a rate generally based on the appropriate market value for that service in their area), the rate insurance has agreed to pay the provider for that service (allowed amount), and the amount you are expected to contribute (patient responsibility). Providers cannot recover any of the lost fees between their market value and the "allowed amount" imposed on them by insurance contracts. The provider is forced to write off the difference. They can request better rates, but insurance companies ultimately determine the reimbursement rate and the provider has to either accept the negotiated rate offered by insurance or choose not to be in-network with that insurance. If the provider is out of network, insurance will reimburse providers their full rates at the consumer's expense, as you often are asked to pay a higher co-insurance for out-of-network services provided. 

Feel free to contact us at 512-270-1918 or info@courageousaf.org if you have other questions we may be able to answer or guide you on how to find answers regarding insurance. We understand that insurance can be complicated and are here to help you navigate those difficulties and questions.