May 17, 2024
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May 17, 2024
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Linking Northern and Central NJ, Bronx, Manhattan, Westchester and CT

Rethinking Mental Health: Making Out-of-Network Psychotherapy Affordable

We often find that life isn’t what we expect it to be. Having grown up in a frum, warm home, married just after graduating from Stern and with a successful career in finance, I never anticipated finding myself divorced in my early 30s with two young daughters. Like for most of us where private school tuition and the cost of living is exceptionally high, adding on an extra expense for therapy for yourself or your children may seem untenable.

What I’ve discovered, which you may not be aware of, is that it is possible to get insurance to reimburse you, almost in full, for out-of-network therapy, at a rate of anywhere from $150-$350 per session. As a patient advocate, I help therapy patients, individuals, couples and children negotiate with their insurance plans to get these reimbursements.

Over the last few decades, and even more so since the COVID-19 pandemic began, psychotherapy has become increasingly more mainstream and less and less taboo for the average American. And for good reason. We live in a world where the focus on wellness and fitness has become part of the baseline of popular American culture. Although not shared with the same pride as a daily juicing routine, owning a Peloton bike, or an annual membership to The Gym or Equinox, mental health is a critical piece of our overall well-being. Meditation and mindfulness are the new fashion, with apps galore to guide those seeking inner peace and to achieve a daily state of Zen. Motivational coach Tony Robbins powerfully reminds us that our quality of life is not dictated by material wealth, but by our emotional state: “The quality of your life is where you live emotionally,” he said.

Anxiety. Mania. Depression. Trauma. Personality disorders. ADHD. Loss. Bipolar Disorder. Fear. Mood disorder. PTSD. Eating disorders. Addictions. Victims of abuse. Suicidal ideations. Psychosis.

Mental health challenges come in all shapes and sizes. Each one of these emotions and emotional experiences bring their own set of challenges in people’s daily lives. They can manifest in the ways people relate to ourselves, to friends and loved ones, and even in the workplace among colleagues, bosses and support staff. Whether it’s feeling anxiety over what people think because of the innate desire for others’ approval and acceptance; the overwhelmingly painful feelings that we are not enough, not loved or unworthy of love; feelings of loneliness and isolation; the struggle to feel safe and trust others after experiencing trauma; struggling to live happily in reality, instead of in a perpetual state of disappointment over the way we wish things would be; or feeling stuck, hopeless, helpless, paranoid or trapped, human emotions and the human psyche are complex.

The moving words in the Unesane Tokef prayer, recited on both Rosh Hashanah and Yom Kippur, took on new meaning for me this year as I prayed for my clients who are struggling with mental health related challenges and traumas. “Mi yiShalev, u’mi’yit Yasar—who shall be serene and who shall be tormented.”

Sadly, mental health struggles have the power to suck the joy out of day-to-day life, to hinder our ability to be fully present in each moment, and to prevent us from connecting with our friends, spouses and children in a meaningful way. And for many, it can be an invisible, lonely and debilitating struggle. These are brave souls who are working through the pain, and who are processing difficult emotions so that they can lead a happy life in a beautiful state.

For many, seeing a therapist feels like a luxury that is unaffordable. People generally see their therapist once a week, sometimes more often, and the expense can quickly add up. Whether a person has been in therapy for years, just begun, or is interested in getting started, I am here to help you afford therapy with a qualified and experienced therapist and stay in it as long as needed, without depleting your cash flow or savings.

We all share a human need to contribute. I feel grateful for the opportunity to help and advocate for others. I am passionate about people taking care of their mental health needs through therapy, when appropriate, because I have experienced firsthand how it has supported me and others through even the most challenging times. Making therapy affordable so people can get the therapy they need, with an experienced, qualified therapist, brings me great joy and fulfillment. I am honored to be a part of helping people on their journey toward mental and emotional health and living a life with healthy, meaningful relationships.

My passion is to advocate for mental health reimbursements, where I help psychotherapy patients (individuals, couples and children) who are covered under an employer-sponsored PPO plan, to negotiate with their insurance plan to compel insurance to cover and reimburse the patient for out-of-pocket/out-of-network therapy. (Although many plans cover out-of-network therapy, it is generally at a very low rate of $50-$70 per session, and is a benefit only accessible for a few months of the year once the deductible has been met). In addition to mental health reimbursements, I also advocate for hospital claims.

In the months that I have been advocating, my clients have received anywhere from $5,000- $45,000 a year in reimbursements, depending on the cost and frequency of therapy, with reimbursements ranging anywhere from $150-$350 per session. (Reimbursements under these cases are generally not subject to the deductible, which means reimbursements are received all year).

I recently negotiated a case where a mother and her 10-year-old daughter were each seeing their own therapists, out-of-network specialists, due to the nature of the case. Before the case was negotiated the family didn’t receive any reimbursement because the out-of-network deductible had not been met.The daughter had successfully completed cancer treatments and was struggling with anxiety and behavioral challenges. Her mother was struggling with her own anxiety and how to best support her daughter through a situation in which she could not relate. I negotiated with their insurance plan to cover each therapist up to a $25 copay. In this way, insurance is reimbursing the family $300 per session for one therapist, $250 per session for the other, saving the family over $2,000 per month.

In another recent case, a father struggling with depression and mood disorder was paying $250 per session multiple times a week for psychotherapy. After negotiating with his plan, the insurer is reimbursing him the full $250 per session. Although he had met his out-of-network deductible by the time I negotiated the case, the insurer was reimbursing only $70 per session until January, when the deductible would reset and reimbursements would have again dropped to $0.

If you are currently in therapy, or are thinking about starting to work with a therapist, I welcome the opportunity to help you make therapy affordable.

Although my journey has not been one that I anticipated, it has been an incredibly rewarding one. To those of you who may be struggling with mental health challenges, I wish you a year of good physical health, refuas hanefesh, happiness and fulfillment, and a year where we can see the blessings Hashem bestows on us daily.

For further information, contact Alanna Apfel, patient advocate, at (323) 510-6405 or [email protected].

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