Fed Employees: Health Insurance Advice for Mental Health Coverage, e.g., PPD?

[Anonymous]

I am hoping there may be some BTDT moms here who can provide advice on the best federal health insurance plans for mental health coverage? I suffered with depression and anxiety throughout my entire pregnancy, and my doctors are now diagnosing me with PPD. I have found that nearly all of the psychiatrists in the area do not participate in any health insurance plans, especially my federal plan (BCBS Basic, no coverage for out of network providers).

Now that it's open enrollment, can anyone provide guidance on other insurance plans that might provide better coverage for weekly psychiatric counseling and/or medications necessary for PPD and depression/anxiety? It would be great to not have to pay $250/hour out of pocket each time I go see my therapist. Thank you so much in advance!

[Anonymous]

I have Kaiser Permanente and they have lots of psychiatrists in their plan. They're just a $20 copay and you can get referrals very easily. With Kaiser you can ONLY use their providers, but they have them and they're easily available. I've loved Kaiser for years.

[Anonymous]

I had the same problem, BCBS is terrible if you need to see a psychiatrist. My primary care doctor ended up giving me medicine and I supplemented that with weekly visits with a Therapist.

[Anonymous]

OP again. The problem with BCBS Basic is that there are no reputable providers in-network who have appointments available. Not a single one that seemed legit. I am completely at a loss...how can a woman suffering from PPD while on maternity leave get help when it will cost $1000/month?

Does anyone know about the BCBS Standard plan and whether that's better.

Thanks to the PP who suggested Kaiser. The problem is that the therapists and psychiatrists that have been recommended to me by my OB don't participate in anything.

[Anonymous]

Anonymous wrote:OP again. The problem with BCBS Basic is that there are no reputable providers in-network who have appointments available. Not a single one that seemed legit. I am completely at a loss...how can a woman suffering from PPD while on maternity leave get help when it will cost $1000/month?

Does anyone know about the BCBS Standard plan and whether that's better.

Thanks to the PP who suggested Kaiser. The problem is that the therapists and psychiatrists that have been recommended to me by my OB don't participate in anything.

I think Kaiser, or another plan with good mental health coverage, is worth considering. I wouldn't limit yourself to providers recommended to you, unless you're willing to pay out of pocket.

I had ppd with my first, and found that once the meds kicked in, I was ok.

[Anonymous]

OP again. Thank you. part of the problem I'm having is that I cannot find any psychiatrists in the preferred provider network for BCBS Basic.

Anyone who is a preferred provider isn't accepting new patients. The only preferred providers who are accepting new patients are in strange parts of town, don't seem to specialize in womens issues, or don't seem to have the credentials I am in need of.

I've been on the phone so many times with BCBS trying to get help and find a participating provider, but they cannot offer any suggestions or referrals either. It's been beyond frustrating and makes the anxiety/depression so much worse, when you are trying to reach out and seek help, but no one is willing to work with you unless you have $1000/month.

This board is the only help I've had in what seems like months. I wish I hadn't waited so long to post! THANK YOU!

[Anonymous]

Anonymous wrote:OP again. Thank you. part of the problem I'm having is that I cannot find any psychiatrists in the preferred provider network for BCBS Basic.

Anyone who is a preferred provider isn't accepting new patients. The only preferred providers who are accepting new patients are in strange parts of town, don't seem to specialize in womens issues, or don't seem to have the credentials I am in need of.

I've been on the phone so many times with BCBS trying to get help and find a participating provider, but they cannot offer any suggestions or referrals either. It's been beyond frustrating and makes the anxiety/depression so much worse, when you are trying to reach out and seek help, but no one is willing to work with you unless you have $1000/month.

This board is the only help I've had in what seems like months. I wish I hadn't waited so long to post! THANK YOU!

Have you left any of these providers a message stating that you are suffering from PPD? Most psychiatrists won't make you wait in this situation, even if they have a wait for new patients. I called several (and ultimately paid out of pocket) who returned my call same day and offered to see me within 24 hours, despite having long wait lists.

[Anonymous]

Where are you located? I might be able to suggest providers if you provide location.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP again. Thank you. part of the problem I'm having is that I cannot find any psychiatrists in the preferred provider network for BCBS Basic.

Anyone who is a preferred provider isn't accepting new patients. The only preferred providers who are accepting new patients are in strange parts of town, don't seem to specialize in womens issues, or don't seem to have the credentials I am in need of.

I've been on the phone so many times with BCBS trying to get help and find a participating provider, but they cannot offer any suggestions or referrals either. It's been beyond frustrating and makes the anxiety/depression so much worse, when you are trying to reach out and seek help, but no one is willing to work with you unless you have $1000/month.

This board is the only help I've had in what seems like months. I wish I hadn't waited so long to post! THANK YOU!

Have you left any of these providers a message stating that you are suffering from PPD? Most psychiatrists won't make you wait in this situation, even if they have a wait for new patients. I called several (and ultimately paid out of pocket) who returned my call same day and offered to see me within 24 hours, despite having long wait lists.

The ones who don't participate with any insurance companies called me back immediately (but then I would have to pay $250/hour out of pocket), even if they had waiting lists. The doctors who are considered "preferred providers" (which there weren't many of) never got back to me.

[Anonymous]

Anonymous wrote:Where are you located? I might be able to suggest providers if you provide location.

Downtown DC or Arlington/Alexandria, VA area. So either NoVA or DC proper.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP again. Thank you. part of the problem I'm having is that I cannot find any psychiatrists in the preferred provider network for BCBS Basic.

Anyone who is a preferred provider isn't accepting new patients. The only preferred providers who are accepting new patients are in strange parts of town, don't seem to specialize in womens issues, or don't seem to have the credentials I am in need of.

I've been on the phone so many times with BCBS trying to get help and find a participating provider, but they cannot offer any suggestions or referrals either. It's been beyond frustrating and makes the anxiety/depression so much worse, when you are trying to reach out and seek help, but no one is willing to work with you unless you have $1000/month.

This board is the only help I've had in what seems like months. I wish I hadn't waited so long to post! THANK YOU!

Have you left any of these providers a message stating that you are suffering from PPD? Most psychiatrists won't make you wait in this situation, even if they have a wait for new patients. I called several (and ultimately paid out of pocket) who returned my call same day and offered to see me within 24 hours, despite having long wait lists.

The ones who don't participate with any insurance companies called me back immediately (but then I would have to pay $250/hour out of pocket), even if they had waiting lists. The doctors who are considered "preferred providers" (which there weren't many of) never got back to me.

Just pay the $250 out of pocket and submit to your insurance for out of network reimbursement. With a psychiatrist, you usually won't have to see them every week after getting stabilized. from someone who has BTDT, this is worth the $. Put it on a credit card if you have to.

[Anonymous]

Anonymous wrote:
Just pay the $250 out of pocket and submit to your insurance for out of network reimbursement. With a psychiatrist, you usually won't have to see them every week after getting stabilized. from someone who has BTDT, this is worth the $. Put it on a credit card if you have to.

The OP's problem is that her BCBS Basic plan does not reimburse for ANY out of network provider. That is why she is seeking advice on other plans. She has to pay the $250 and doesn't get reimbursed at all.

[Anonymous]

OP, if you go with the BCBS STANDARD plan instead of BCBS Basic, you will get some coverage for out of network providers.

Obviously the coverage is better for anyone in-network, but as we all know, these folks are hard to find.

So, I would opt for the BCBS Standard plan. It's more expensive and has a deductible, but you get out of network coverage for everything. With the Basic plan, if you need a specialist or psychiatrist who is out of network or doesn't participate you're stuck paying it ALL out of pocket.

[Anonymous]

NP here. Does anyone have experience with what the situation is with MDIPA?

[Anonymous]

With the mental health parity law your insurance MUST cover mental health treatment at the same level as physical health conditions. By law they CANNOT make the co-pays more expensive or put other restrictions that do not exist for physical health.

If there are network does not have ANY mental health providers, psychiatrists, psychologists, social workers or licensed clinical counselors that are in network and have appointments available you need to argue the case that they pay out of network even if you don't have out of network coverage. They are essentially limiting your benefit by putting artificial barriers in the way of you getting treatment. You could raise this via your HR department, but many people are reluctant to do so because of stigma. You can raise it with the insurance commission for your state, you can raise it with a supervisor for your insurance company and finally you can complain to HHS because they are not abiding by the mental health parity law. The insurance company should not matter -- it is the LAW that your coverage should comply with. I'm sorry that you are faced with this.