Is it a bad idea to submit my psychiatrist visits to my insurance?
August 6, 2013 8:42 PM   Subscribe

I'm seeing a psychiatrist. I'm paying for it up front through my HSA and not submitting it to my insurance company. I switched to a new practice recently and because it's more expensive, I wonder if I should submit these claims to my insurer. Should I be?

I am a physically healthy, 28 year-old woman in Illinois.

I am seeing a psychiatrist for depression, anxiety and the appropriate medication and therapy. I make enough money that I don't qualify for anything sliding scale or government-provided.

Right now I am only seeing a medical doctor at this practice for medication maintenance, but I would really like to go more often to one of their psychologists for plain ol' psychotherapy.

I have a high-deductible ($5k) health plan through my employer but hope to be independently contracting in the next five years or so, which will require me to apply for private insurance. Spouse is already a contractor and is on my insurance plan.

There's a chance that insurance will reimburse me for part of my therapy costs, but my insurer's website is really unclear on that.

I'm paying $200 per appointment and would love for that to go toward my deductible, but I'm terrified that disclosing my mental health to my insurance company via submitting claims for these therapy appointments will hurt our chances of getting decent insurance down the line. We could be denied outright or charged a super high premium.

Should I start submitting these claims? Is there anything in the new Affordable Care Act that will act as protection against my rates going sky-high down the line because I disclosed my diagnosis? Please help me, because I am totally lost as to what to do!
posted by anonymous to Work & Money (8 answers total) 4 users marked this as a favorite
Are you already getting your prescriptions through your health plan? If you are and depending on how many other uses there are for that drug, it may already be obvious to your insurance company.Also, if you are submitting your claims to your HSA they may possible be visible to your insurance company as well, if they are involved in the management for the HSA.

If you are the US, then my understanding is that the new healthcare laws should prevent them from denying you insurance due to your existing health issues (mental health included) and will not be able to charge you more money because of it. (double check this for yourself before relying on it.)

Finally, if you don't disclose it when you apply for private insurance and they find out later that you lied on your application, they can come after you for lying. I don't know how likely it is that this would become an issue but it is a risk to not disclosing it yourself in your application.

So, it is possible that (a) they are already aware of it (through prescriptions or HSA), (b) it may not make a difference for future coverage and (c) you may want to disclose on future applications yourself anyway.
posted by metahawk at 8:53 PM on August 6, 2013

I work in the industry currently, but on the group insurance side. I have a few suggestions.

1) For any situation where you apply for individual insurance, just because you don't file claims does not mean that you are not obliged to disclose the information in a health and background questionnaire. Whether you want to meet the obligation or not, you would be signing a contract that states X is true. If you state that Y is true instead, that can invalidate the contract and can get insurance canceled in some cases.

2) Unless you meet your deductible, a HSA is not permitted to pay anything with the exception of preventive care, which does not include therapy or mental health medications. That is an IRS regulation, not an insurance company thing. (Personally, I think it is dumb. Someone pays for the benefit somewhere.)

3) Your employer may offer what is call a "conversion plan" where you are able to go into a comparable individual plan. Frequently, it can be a richer plan than you could get as an individual, but it generally costs more than COBRA does, so not always an option.

4) If you are getting medications and using your HSA funds, then a paper trail exists, period. Using your full benefit plan doesn't hide that.

5) For the PPACA legislation, the marketplaces are really the only protection in there and then only by saying that competition will keep prices down, but the up-side is that what you are describing is generally no more expensive than chiropractic care. Real cost differences get in on degenerative or severe, systemic items. Example, diabetes doesn't go away and can cost hundreds of thousands from hospital charges over the years. Mental health care is rarely more than a few hundred a month, so it does not sound like you would hurt yourself much in any case.
posted by slavlin at 9:06 PM on August 6, 2013 [4 favorites]

As for whether or not they'll pay even if you send them the bills - keep in mind that even if you call customer service and ask if they're going to cover it under your plan, the final determination of what they feel like paying for is only made after they receive the bill. And after they receive every subsequent bill. They can actually tell you anything they want over the phone about what they cover, but you have no way of knowing until you have the bill, and then you're stuck with it.

Also keep in mind that the pre-existing conditions parts of the Affordable Health Care act don't kick in until 2014 so that won't help you if you switch insurance this year. Until then, there are all kinds of wacky rules about what is and what is not allowed, and they differ for individual plans vs. employer plans. You should read up on it.
posted by bleep at 9:10 PM on August 6, 2013

The Affordable Care Act will very much protect you; as metahawk says, insurers will not be able to charge more for or deny claims from pre-existing conditions.
posted by jaguar at 9:58 PM on August 6, 2013

2) Unless you meet your deductible, a HSA is not permitted to pay anything with the exception of preventive care, which does not include therapy or mental health medications.

That is not at all my understanding of, or experience with, an HSA. I've used my HSA to pay for my out-of-pocket medical expenses including non-preventative care, without meeting my deductible. Here's a link to the relevant IRS publication. It lists the medical expenses that are considered includible and not includible, and specifically lists therapy and psychiatric care as includible expenses.
posted by Majorita at 6:29 AM on August 7, 2013 [1 favorite]

File the claims. Have them count towards your deductible.

You're protected under the Affordable Care Act. Also, everyone and his brother is on meds for depression. I don't actually know too many people who aren't. (Perhaps we're inclined to pal around with each other.)

Seeing a psychiatrist isn't bad, being depressed isn't bad.
posted by Ruthless Bunny at 8:57 AM on August 7, 2013

I use my HSA for psych meds, therapy and psychiatrist, before and after I meet my deductible. According to HR at my workplace, this is legal and proper. Your HSA may differ from mine. It is my understanding that the IRS stopped use of HSAs for OTC drugs a couple years ago, but not dental, psych, vision, etc. IRS Publication 502 clarifies this.

ACA will help, but not yet.
posted by QIbHom at 10:11 AM on August 7, 2013

Just wanted to add that you will be able to purchase individual insurance through the state exchanges next year. They will not be able to deny you due to a pre existing condition. The rates are regulated as well, so you shouldn't get some ridiculous rate. The insurance companies have already factored in the sickest and the healthiest (well, they did the best they could given they are just guessing about the currently uninsured population). Every state is operating a bit differently, some have private exchanges, while others are on the federal exchange. It's worth looking into.

Also, I work at an insurance company now. I spend a lot of time looking at high cost claims and predominant health conditions for populations. Trust me, treatments for depression/anxiety are so not a concern cost-wise. They're incredibly common, in fact. If I were in your situation, I would not worry at all about getting these treatments covered by my health insurance, and they are my employer.
posted by smalls at 5:35 PM on August 7, 2013

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