Upon starting a new job, or during open enrollment, many of our clients and prospective clients call to ask which plan they should choose from the list that their employer gives them.
While we can’t tell you what insurance plan is right for you, we can give you an overview of the things you should be thinking about, especially if you are prioritizing mental health services.
Typically, employers give different options within three main types of plans: HMOs, PPOs, and EPOs. HMOs, or Health Maintenance Organizations, usually only offer coverage within their health organization — these are often major hospital systems like Kaiser or Sutter Health. EPOs, or Exclusive Provider Organizations, offer coverage for only a specific list of providers, often with little to no out-of-network benefits. PPOs, or Preferred Provider Organizations, are generally the most flexible: they allow people to choose any healthcare provider and offer both in-network and out-of-network coverage. In any of these cases, insurance plans provide better coverage for in-network providers.
Another thing that employers let you opt into that is separate from your insurance are FSAs and HSAs. These benefit accounts are great options for those with high deductible plans or anyone using out-of-network services. HSAs (health savings accounts) and FSAs (flexible spending arrangements) allow you to use pre-tax dollars to contribute to the upfront costs of care. At Two Chairs, we accept payment for sessions using the debit card associated with your account, or we can send you receipts to submit to your FSA/HSA administrator for reimbursement.
A major source of frustration for many people attempting to navigate the insurance system is the lack of in-network providers. When trying to find an in-network provider, you are often met with weeks or even months of unanswered phone calls and emails. Often when you are able to finally speak with someone, you learn that the provider is not accepting any new patients. Finding in-network care is especially difficult when looking for mental health care. We hear this story from clients and teammates over and over — in fact, it was one of the reasons our founder started Two Chairs in the first place.
Two Chairs, like 80% of therapy providers in the United States, is an out-of-network provider. This is because insurance companies choose to maintain narrow networks. Since most mental healthcare providers are out-of-network, PPO plans are usually the best choice because they have out-of-network benefits. Despite how common it is, navigating out-of-network insurance is challenging, and insurance companies don’t always have readily available resources to make it easier. Our Care Coordination team at Two Chairs is here to help you navigate this process, step by step.
If you’re interested in learning more about your specific benefits or have questions about starting care at Two Chairs, you can schedule a call with us here.
We also wrote two other articles that address commonly asked questions about insurance:
If you or someone you know is seeking mental health care, you can reach out to our Care Coordination team at [email protected] or by phone at (415) 202-5159.
If you or someone you know is experiencing an emergency or crisis and needs immediate help, call 911 or go to the nearest emergency room. Additional resources can be found here.