Anonymous wrote:+1000 - re the travesty of the reimbursement and the need for an investigation. Our mental health care costs are bordering on more than housing. It is outrageous. We don't have a choice really because DC's mental health needs are extreme. I cried my way into CNMC but they were overwhelmed by our needs. Of course, they were not upfront about it - I had to ask if that was the case and they admitted it. No one knows how to help us really.

We have paid more a month in services then our mortgage. It sucked.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think there needs to be federal investigation into the “allowed amount” bullshit. $80/hour is not the going rate for therapy anywhere. They should be required to reimburse based on the actual real world price paid by the insured

$80 for 30/45 minutes is reasonable. If they up the allowable charge, then the providers will just increase their rates even more. If a provider is in-network, they are required to take that amount and you co-pay and that's it.

Who does therapy for 30 minutes?

I'm sure there are calculations that practitioners use to figure out how much they need to charge to be able to afford rent, insurance, support staff, professional licensing, etc. I know a lot of therapists and none of them are getting rich. Why don't the insurance companies have to use some of those same numbers when calculating the allowed amount?

Our insurance would only approve 30 minutes a day. It was bizarre as we could go multiple times a week.

Seriously! I need therapy to pay for the stress related to finding therapists who take insurance. If you are in DC, one suggestion would be to look for therapists in Prince George's County. The therapists (specifically OT and ST) here charge less than those in Montgomery County.

Anonymous wrote:+1000 - re the travesty of the reimbursement and the need for an investigation. Our mental health care costs are bordering on more than housing. It is outrageous. We don't have a choice really because DC's mental health needs are extreme. I cried my way into CNMC but they were overwhelmed by our needs. Of course, they were not upfront about it - I had to ask if that was the case and they admitted it. No one knows how to help us really.

+1. I got $20 per 185 per 45 minute session with a psychologist and also had no idea that the deductible was only met when payments exceed the "allowable amount," i.e. nothing. Has it always been this way? I had no idea.

Therapist bills us $190 per 50 minute session; we get reimbursed (eventually) $112.50. Federal plan. I'm shocked to learn from reading these messages that apparently this is a good rate. We are doing three sessions per week, so still 1k out of pocket per month.

Anonymous wrote:

Anonymous wrote:I think there needs to be federal investigation into the “allowed amount” bullshit. $80/hour is not the going rate for therapy anywhere. They should be required to reimburse based on the actual real world price paid by the insured

$80 for 30/45 minutes is reasonable. If they up the allowable charge, then the providers will just increase their rates even more. If a provider is in-network, they are required to take that amount and you co-pay and that's it.

Who does therapy for 30 minutes?

I'm sure there are calculations that practitioners use to figure out how much they need to charge to be able to afford rent, insurance, support staff, professional licensing, etc. I know a lot of therapists and none of them are getting rich. Why don't the insurance companies have to use some of those same numbers when calculating the allowed amount?

Anonymous wrote:I think there needs to be federal investigation into the “allowed amount” bullshit. $80/hour is not the going rate for therapy anywhere. They should be required to reimburse based on the actual real world price paid by the insured

$80 for 30/45 minutes is reasonable. If they up the allowable charge, then the providers will just increase their rates even more. If a provider is in-network, they are required to take that amount and you co-pay and that's it.

+1000 - re the travesty of the reimbursement and the need for an investigation. Our mental health care costs are bordering on more than housing. It is outrageous. We don't have a choice really because DC's mental health needs are extreme. I cried my way into CNMC but they were overwhelmed by our needs. Of course, they were not upfront about it - I had to ask if that was the case and they admitted it. No one knows how to help us really.

Anonymous wrote:I think there needs to be federal investigation into the “allowed amount” bullshit. $80/hour is not the going rate for therapy anywhere. They should be required to reimburse based on the actual real world price paid by the insured

Amen to that.

I think there needs to be federal investigation into the “allowed amount” bullshit. $80/hour is not the going rate for therapy anywhere. They should be required to reimburse based on the actual real world price paid by the insured

I cannot afford out of network therapist even I hear some of them are really awesome for my DC. I only do in-network ones, and pay up to $2000 a year. DC has 5 weekly therapies, so once I pay up to $2000, I don't have to pay anything.

Anonymous wrote:I gave up putting in claims. On $11,000 worth of bills. in a year, we got back around $400. Not even worth the time I spent filing the claims every month. I think this is a phenomenon of expensive cities. When we lived elsewhere, it was more common for mental health professionals to be in-network.

For my own therapy, I've been pleasantly surprised that the quality of in-network therapists in DC has improved substantially over the past 15 years. I think that's because there's now better software/apps that lets the better therapists handle all the insurance paperwork. But this is just for simple talk therapy, where I need a good person to hear me out and help me think things through. For the more targeted, evidence-based therapies (behavioral, CBT) I've had to go out of network for myself and my child.

Anonymous wrote:I have United HealthCare and we get back 60 percent of what we pay for therapy (not 60 percent of what they THINK we should pay). We pay $215 per session so that's a good chunk of money.

that's extremely unusual. every single plan I've looked at (of the fed plans) the reimbursement is for a percentage of the "allowed amount."

Yep, sadly, that is typical. Reimbursements are so low that I opted to chose a cheaper plan without any out-of-network benefits, because I knew that doing all that paperwork just to recoup $30/session would not be worth my time or the money.

I have United HealthCare and we get back 60 percent of what we pay for therapy (not 60 percent of what they THINK we should pay). We pay $215 per session so that's a good chunk of money.