Switching from Kaiser to Anthem for mental health reasons
November 12, 2019 12:33 PM Subscribe
After a lifetime (literally) at Kaiser I'm considering switching to Anthem, primarily so I can start going to therapy (Kaiser is terrible for me in that regard). But, Kaiser in every other aspect is so dang easy. What should I consider before making the switch?
For what it's worth, my employer plan options are an "EPO" plan which would be $5/mo cheaper than Kaiser, or a "Select PPO" plan that is $30/mo more. Select PPO charges $20 per mental health office visit in-network, and 70% out-of-network ($750 deductible), whereas the co-pay is just $20 per visit. I also have prescriptions-- buproprion (daily) and lorazepam (occasional)-- the cost under Kaiser is nominal. $10 maybe. I have no other major ongoing health needs, no pregnancy on the horizon, etc. I'm in LA, so therapists abound, but I don't know the quality of Anthem's network or what the going rates are (i.e. what 30% would cost me).
Financially, I'm prepared to pay a bit more, like say $100-200 a month, but I can't afford regular therapy on my own.
For what it's worth, my employer plan options are an "EPO" plan which would be $5/mo cheaper than Kaiser, or a "Select PPO" plan that is $30/mo more. Select PPO charges $20 per mental health office visit in-network, and 70% out-of-network ($750 deductible), whereas the co-pay is just $20 per visit. I also have prescriptions-- buproprion (daily) and lorazepam (occasional)-- the cost under Kaiser is nominal. $10 maybe. I have no other major ongoing health needs, no pregnancy on the horizon, etc. I'm in LA, so therapists abound, but I don't know the quality of Anthem's network or what the going rates are (i.e. what 30% would cost me).
Financially, I'm prepared to pay a bit more, like say $100-200 a month, but I can't afford regular therapy on my own.
Be sure to check whether your company has a separate Managed Mental Health Care Program (MMHCP). I'm not saying this is always the case, but I have worked for at least three companies where mental health was not on the main insurance menu. And it's not always well-documented.
posted by ubiquity at 1:07 PM on November 12, 2019
posted by ubiquity at 1:07 PM on November 12, 2019
Yeah, unfortunately many therapists don’t take insurance for a lot of reasons, one of which is that insurance companies may require them to submit session notes and many therapists have major ethical reservations about that. Anthem is...not great with reimbursement, in my experience and you may end up on the hook for hundreds of dollars. But you may luck into a great therapist who takes Anthem! Check around first to see if anyone returns your call, as was mentioned above. Anthem’s search engine for finding providers is absolutely dreadful so the Psychology Today site, while not perfect, can be useful.
posted by corey flood at 2:01 PM on November 12, 2019
posted by corey flood at 2:01 PM on November 12, 2019
Anthem will do everything it can to avoid paying for your therapy. You'd be better off sticking with Kaiser and paying out of pocket, because you will be paying out of pocket anyway.
posted by medusa at 2:29 PM on November 12, 2019 [7 favorites]
posted by medusa at 2:29 PM on November 12, 2019 [7 favorites]
I wasn’t in your exact situation, but I ended up staying with Kaiser and paying out of pocket at a sliding scale clinic for therapy, and overall it worked out.
posted by jameaterblues at 2:59 PM on November 12, 2019 [1 favorite]
posted by jameaterblues at 2:59 PM on November 12, 2019 [1 favorite]
I switched from Kaiser to Aetna to get better access to therapy. Not because the network was better, but because Kaiser doesn’t allow out-of-network care. My therapist is out of network, and I submit my bills each month, and wait for reimbursement.
Mental Health parity has meant that I’ve never had my frequency or cost questioned. But I pay 40% until I hit my max out of pocket. So I’m usually paying full price the first few months till I hit my deductible. I go ... a lot, and hit my max and have free health care the last few months of the year.
It might not be worthwhile if you can’t afford paying ahead and waiting for reimbursement. Finding a sliding scale Therapist might be more sustainable.
posted by politikitty at 5:00 PM on November 12, 2019
Mental Health parity has meant that I’ve never had my frequency or cost questioned. But I pay 40% until I hit my max out of pocket. So I’m usually paying full price the first few months till I hit my deductible. I go ... a lot, and hit my max and have free health care the last few months of the year.
It might not be worthwhile if you can’t afford paying ahead and waiting for reimbursement. Finding a sliding scale Therapist might be more sustainable.
posted by politikitty at 5:00 PM on November 12, 2019
I've been on Anthem for ~10 years and they have always paid my (out of network) therapy according to their rates.
In practice, I get about ~70% of the amount my therapist charges back. I've never had any claims denied.
posted by thefoxgod at 5:00 PM on November 12, 2019 [1 favorite]
In practice, I get about ~70% of the amount my therapist charges back. I've never had any claims denied.
posted by thefoxgod at 5:00 PM on November 12, 2019 [1 favorite]
My wife and I have been on Anthem PPO for almost ten years, and we have yet to get them to pay more than $25 dollars on a single therapy visit. That's after multiple appeals, and paperwork every single month. I had to quit, and my wife had to just pay out of pocket for her transition-related therapy.
posted by headspace at 5:44 PM on November 12, 2019
posted by headspace at 5:44 PM on November 12, 2019
I have an Anthem PPO and they told me they wouldn't pay any part of the fees for therapy until my deductible had been met, even though the booklet of coverage information makes it look like they'll cover 90% of each appointment. YMMV
posted by Penguin48 at 6:50 PM on November 12, 2019
posted by Penguin48 at 6:50 PM on November 12, 2019
When I had an Anthem PPO I had no problems getting my therapy fees covered when in-network, but I had issues getting claims approved for other (also in network) medical stuff due to billing codes which took months to resolve.
But... I'm in the Bay Area and I want to second that many therapists nowadays do not take insurance at all and the average going rate (at least here) would be outside of your intended budget unless you are going like, once a month.
I have a different insurance provider now but it has a lower deductible and a higher coinsurance than what you've described, and no copay for out of network. Even still I found the up-front cost hard to swallow.
So my advice is to do some research first if possible You may find a therapist who is willing and able to work with you in a way that will be less expensive than switching insurance companies.
posted by sm1tten at 8:27 PM on November 12, 2019
But... I'm in the Bay Area and I want to second that many therapists nowadays do not take insurance at all and the average going rate (at least here) would be outside of your intended budget unless you are going like, once a month.
I have a different insurance provider now but it has a lower deductible and a higher coinsurance than what you've described, and no copay for out of network. Even still I found the up-front cost hard to swallow.
So my advice is to do some research first if possible You may find a therapist who is willing and able to work with you in a way that will be less expensive than switching insurance companies.
posted by sm1tten at 8:27 PM on November 12, 2019
I have an Anthem PPO and they reimburse ~70% of my out-of-network therapy after I meet my yearly deductible. I have to file the paperwork myself, the forms are obnoxiously low-tech, and one time they randomly denied a bunch of claims for no real reason but then immediately rolled over when I appealed.
Note that the exact math for you will depend on your deductible, out of network coverage percentage, and how much other health care you'll be getting the same year to count towards the deductible.
It's worthwhile for me because getting the partial reimbursement helps prevent me from talking myself into stopping therapy for financial reasons. I'm not sure if my overall healthcare spending is much less than Kaiser, but therapy *feels* cheaper on a per-visit basis, which makes it easier to stick with it.
posted by introcosm at 8:35 PM on November 12, 2019
Note that the exact math for you will depend on your deductible, out of network coverage percentage, and how much other health care you'll be getting the same year to count towards the deductible.
It's worthwhile for me because getting the partial reimbursement helps prevent me from talking myself into stopping therapy for financial reasons. I'm not sure if my overall healthcare spending is much less than Kaiser, but therapy *feels* cheaper on a per-visit basis, which makes it easier to stick with it.
posted by introcosm at 8:35 PM on November 12, 2019
This thread is closed to new comments.
1. Therapists certainly abound here, but it's VERY hard to find one who takes insurance. Like, from what I've seen from my patients, close to impossible. (And I've had patients calling dozens of in-network providers and not getting a call back.) They don't have to, so they don't. Many of them are out-of-network and your insurance will reimburse you, but not the full rate (and some insurance will reimburse you a % of what they THINK the therapist should charge, not what they actually charge). And you still have to front the money and then wait for the reimbursement. I don't want to be doom and gloom, but do want to warn you it's difficult if you're wanting to use insurance. The rate is all over the place, and from what I've gathered ranges from $100-$500 an hour. It's all very opaque, in a way I find frustrating.
2. You might have trouble getting the lorazepam refilled with a new psychiatrist, as it's a controlled substance and you're a new patient.
I would do a lot of research now on Anthem's website and maybe start contacting some therapists in-network just to get a sense of if they are taking on new patients, and if they are in-network, etc etc. You could also search on psychology today and filter by anthem (though of course there's also the consideration of the type of therapy you're looking for)
posted by namemeansgazelle at 1:06 PM on November 12, 2019 [3 favorites]