I’m always going to have to manage my mental health issues. – James Arthur
Often patients with insurance seek OCD treatment from providers/clinicians who do not accept insurance. Many clinicians do not take insurance because reimbursement rates have declined and insurance companies often do not honor out of network claims. How do individuals with insurance pay for OCD treatment from a clinician who does not accept insurance?
There is a ‘secret’ that your insurance company doesn’t want you to know. Often state insurance rules and regulations say that insurance companies are responsible for providing you adequate treatment by qualified and trained practitioners. Especially if you belong to an HMO, are required to see doctors in your plan, and not covered by out of network providers. OCD specialists are in short supply, and you are unlikely to find an OCD specialist even if provider profiles state they treat OCD. The bottom line is many specialists do not work for insurance plans including OCD specialists.
The first step to get approval is to call your insurance company and ask if any of practitioners treat OCD. Before you make this first call, a word of caution. Get the full name of each person you talk to and take notes of every conversation. Insurance companies often ‘forget’ information provided and commitments made. Ask for the name of a local clinician who treats OCD. Find out their location. Usually, there are rules that state you do not have to travel outside a certain radius to see a clinician.
Of the clinicians you are referred to you will most likely find they are not taking new patients, or do not treat OCD. Often when patients come to see me they tell me, they have been to many therapists who did not know how to treat OCD. It is imperative to question (or grill) prospective clinicians on how many cases they have treated? What methods do they use? The clinician should indicate Cognitive Behavioral Therapy/CBT and Exposure Response Prevention/ERP. Specifically, what training have they had to treat OCD? Clinicians with little or no experience and training will not be able to answer your questions assuredly. If none of the clinicians pan out, proceed to the next step. You can now ask your insurance company to allow you to see the therapist of your choice.
The next step is to inform your insurance company that you have found a qualified and competent clinician to treat your OCD. It is important that you do your homework before you call your insurance company. The clinician should be a qualified, competent and licensed, mental health counselor, clinical social worker or psychologist.
If your insurance company agrees to your request for an out of network provider, they will contact the clinician and negotiate an “ad hoc,” “out-of-network,” or “single case agreement.” The clinician will be paid their full fee, without you paying more than co-payment.
Michael is a Licensed Mental Heath Counselor and a local authority on the treatment of OCD and Anxiety Disorders. Located in Winter Park he helps adolescents, adults and families battling OCD and Anxiety Disorders. He also provides treatment for Hair Pulling (Trichotillomania) and Skin Picking Disorders. He is a Certified Cognitive Behavioral Therapist and Diplomate of the Academy of Cognitive Therapy. Michael is also an active member of the International OCD Foundation. His passion is helping people and families struggling with OCD/anxiety disorders and increasing public awareness about OCD.