Insurance Issues

I do not participate in any insurance networks or managed care panels; I am also unable to offer direct insurance billing. I provide receipts when desired, which may be submitted for insurance reimbursement. A portion of the cost of my services is generally covered by insurance that provides out-of-network benefits.

Insurance companies require a diagnosis in order to pay for services; some people choose not to seek insurance coverage in order to maintain privacy regarding their diagnosis or condition. Since the Affordable Care Act (ACA) prohibited health insurance discrimination based on pre-existing conditions, having a diagnosis on record is less problematic than it used to be. The ACA’s prohibition does not apply to other forms of insurance such as life and disability, however, so a diagnosis on a health insurance claim may affect the availability or terms of other forms of insurance sought in the future.

Many insurance policies still require prior authorization and treatment plans for mental health services, though this is becoming less common as more insurers comply with parity laws. If you wish to obtain insurance coverage for mental health services, you should contact your insurance company before seeking services to determine your benefits and to obtain prior authorization if necessary.

If you need help getting your insurance company to pay for mental health services, you should know that both the federal government and the state of Maryland have strong Parity laws, requiring insurance plans to cover mental health services in a way that is on par with their coverage of other medical care. Most, but not all, insurance plans are required to comply with these laws. The American Psychiatric Association has a fact sheet on the federal law with some suggested resources, which can be downloaded here. You can also get many answers and get help advocating for yourself by contacting the Maryland Parity Project.

If you are having trouble finding a psychiatrist who takes your insurance, you should know that Maryland’s Network Adequacy law requires insurance companies to pay for care that is accessible and timely. If you cannot get a timely appointment with an accessible in-network provider, your insurance company is required to pay for out-of-network care that is available. They are unlikely to offer this voluntarily. You can get help with how to negotiate this with your insurance company from the Mental Health Association of Maryland, which focuses on advocacy and public policy.