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specialists and insurance

By JENBOBO Tuesday, September 18, 2007
I have been desperately looking for specialists in bipolar disorder.  I finally got some names but none take my daughter's health insurance.  Which is the best health insurance out there for people who suffer from bipolar disorder and want to see a specialist?  Thanks, Jenbobo
Anonymous
tabby
9/18/07 6:11pm

There really isn't any one best insurance for mental health.  It depends on the different plans, whether they have behavioral companies underwriting their MH benefits, what area you are in, etc..

 

A great deal of MH professionals in private practice do not accept insurance or accept only certain ones because of the reimbursement rates being low or the hassle of keeping track of client's different insurance benefits, sending claims, etc..

Also, a lot of insurance plans covering MH unfortunately have very low coverage amounts, limit number of visits, have very high deductibles for MH because MH isn't considered on the same level as medical.

 

You may want to have your daughter seen by these specialists but you'll have to file her own claims with her insurance company yourself.  Most insurance companies have what is called an out of network coverage which pays very little however, it does pay something.

 

You might want to check and see if her coverage has this.  If so, you'll want to check to see how you go about filing claims on your own.

 

 

9/19/07 12:43pm
Thank you very much for your advice Tabby, I appreciate it.  God Bless, Jen.
9/19/07 1:36pm

Hi,

Don't give up on this. There should be a phone number with your insurance company that can lead you in the right direction.  I had to go through a "screening" with my insurance company before they would let me go through their behavioral department which is through another area of them. Once that got approved I was on a trial basis to determine how many visits I was allowed. I am fortunate to only have to pay a $15 co-pay each visit but they do a re-evaluation every few weeks to determine if I should be allowed more visits as they only allow so many in a certain period. I guess they think I need the visits because in the last year and a half they keep approving more. It does come down to the insurance but there has to be some specialists out there that do take yours. You have a better shot at it if you stay away from private practices and find a group practice. A lot of them will take many different insurances. If it's an HMO they should have a directory of in network doctors. The problem comes when you go to an out of network one. That's when the money starts getting high. So I would either call her primary care physician and see what they can do or call the insurance company and ask them to help you find a specialist. A lot of doctors give you a discount if you are a self-pay patient and pay on the day of service but that can still add up quite a bit. It's very sad that so many people who suffer from this can't get the right kind of treatment because of insurance companies not willing to cover the costs of the kinds of doctors we need and the special medications. It's horrible that the help is right there in front of us and yet many of us can't get it all because the medical world still has a hard time accepting mental health on the same level as other health issues and the insurance companies follow along with them. I hope you find the help you need for your daughter. Just keep searching.

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By JENBOBO— Last Modified: 10/26/11, First Published: 09/18/07