Core Health Insurance may not cover therapist

January 1, 2010

Q: I see a licensed therapist in another state far from where I live. She is not in any network. I don't want to change. So I see her for 2 hours and twice a month. Under her care, I also take meds for depression. What exactly will Core Health Insurance pay? 

A: The benefits that Core Health Insurance will pay are listed in the chart in the article at "Review of Core Health Insurance". Note that each type of benefit is listed separately and the maximum dollar amount of the benefit is also defined. As long as you understand this list if benefits and do not assume that items not listed are also covered, then you will have no trouble figuring what expenses will be covered. Core Health Insurance is known as a "limited benefit" or "supplemental" insurance plan because it covers only the items listed and does not cover all other expenses which might incur. This is what makes this insurance affordable and available to everyone.

It does not matter that your therapist is not in a network or not in your state. It does not matter that your visits are for a pre-existing medical condition. What does matter is whether your therapist is a doctor or not. Note that the policy covers up to five doctors office visits up to $100 each for doctors, but no out-patient benefits for office visits to providers who are not doctors.

The key issue here is that many therapist are not doctors and would not be covered under an insurance plan provision that covers doctors visits. There is no separate provision for coverage of office visits to medical providers who are not doctors.

Regardless of the type of health insurance that may be available, patients being treated for depression tend to be dissatisfied with their insurance benefits for this treatment. U.S. health insurance plans are universally designed to keep a significant portion of the cost of outpatient mental health treatment as an out-of-pocket cost to the patient.

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