Federal insurance with best mental health coverage

[Anonymous]

We have federal blue cross PPO (the standard plan not basic). Should we be considering a different plan for better coverage of child psychiatrists and therapists? The out of network therapist charges $200/hour and we get about $60 reimbursed. The psychiatrist charged $200 for a 30 minute medication management. Can't remember what our reimbursement is but I think it's around the same, maybe slightly higher.

[Anonymous]

I thought part of the ACA was mental health was covered the same as physical health?

[Anonymous]

Anonymous wrote:I thought part of the ACA was mental health was covered the same as physical health?

NP. It basically is.

The OON reimbursement rate for all services is low with Carefirst. But there are far fewer in-network providers, so many people only go OON for mental health.

The only real solution for OP is to find a lower priced psychiatrist, so the gap between allowed amount and amount charged is lower, or go in network. I don't think any other federal plans are better on this one piece.

[Anonymous]

NALC high will cover 70% of out of network costs. I think that's the most you will for out of network inder federal plans.

[Anonymous]

Anonymous wrote:I thought part of the ACA was mental health was covered the same as physical health?

The issue with mental health providers in the DC area is hardly any of them actually take insurance, so the only benefits that really matter are the out of network reimursement/deductiblle rates

[Anonymous]

Anonymous wrote:

Anonymous wrote:I thought part of the ACA was mental health was covered the same as physical health?

The issue with mental health providers in the DC area is hardly any of them actually take insurance, so the only benefits that really matter are the out of network reimursement/deductiblle rates

Exactly. I don't think it matters at all what your coverage is. Almost nobody in the mental health field in DC takes insurance.

With this in mind, it is much better to have the federal Standard plan because at least you can submit for reimbursement and get a fraction of the cost back. With Basic you can't.

[Anonymous]

Anonymous wrote:NALC high will cover 70% of out of network costs. I think that's the most you will for out of network inder federal plans.

Undoubtedly NALC puts a ceiling on the total fee of which 70% is covered. Any idea what that is? It's x percent of y dollars, and so it doesn't help to know just one figure.

[Anonymous]

We use INova behavioral health which is in the BCBS network, so our psychiatrist for medication management is only $25 (same as a primary care physician). Few psychologists in network. Our os out of network. She charges $130/visit. We get about $65 back from insurance for each visit.

[Anonymous]

Anonymous wrote:

Anonymous wrote:NALC high will cover 70% of out of network costs. I think that's the most you will for out of network inder federal plans.

Undoubtedly NALC puts a ceiling on the total fee of which 70% is covered. Any idea what that is? It's x percent of y dollars, and so it doesn't help to know just one figure.

I am not sure what the exact ceiling but it seems pretty reasonable compared to costs in our area since typically I get back 65 to 70%.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:NALC high will cover 70% of out of network costs. I think that's the most you will for out of network inder federal plans.

Undoubtedly NALC puts a ceiling on the total fee of which 70% is covered. Any idea what that is? It's x percent of y dollars, and so it doesn't help to know just one figure.

I am not sure what the exact ceiling but it seems pretty reasonable compared to costs in our area since typically I get back 65 to 70%.

https://www.nalchbp.org/high-option-plan/member-resources/publications/body/2017-High-Option-SBC.pdf

[Anonymous]

The difference in premiums between BCBS Basic and BCBS Standard is pretty substantial. You need to make sure you are not paying more in premiums than you would save getting some of the fees reimbursed.

[Anonymous]

Anonymous wrote:The difference in premiums between BCBS Basic and BCBS Standard is pretty substantial. You need to make sure you are not paying more in premiums than you would save getting some of the fees reimbursed.

The difference is less than $200 a month pre-tax. We definitely make that up between reimbursement for out of network and the other reimbursements that are better on standard (co-pays, lab work, etc.).

[Anonymous]

I was looking at this and think GEHA Standard plan might be best. The premiums are low and after you meet your deductible, they cover 65% of out of network doctors/specialists.

[Anonymous]

Anonymous wrote:I was looking at this and think GEHA Standard plan might be best. The premiums are low and after you meet your deductible, they cover 65% of out of network doctors/specialists.

65% of what? The actual charges?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I was looking at this and think GEHA Standard plan might be best. The premiums are low and after you meet your deductible, they cover 65% of out of network doctors/specialists.

65% of what? The actual charges?

They set an allowance, just like the Carefirst, and pay 65% of that.

https://www.geha.com/~/media/Files/Brochures/Health-Brochures/2017StdHighBrochure.pdf