How to Keep Your Therapist While Enrolling in Employer-Sponsored Health Insurance

Finding a therapist you connect with can be life-changing, and it’s understandable to want to keep working with them even when your insurance changes. Navigating this situation can be confusing, but there are options available to help you maintain continuity of care.

Out-of-Network Coverage

One option is to choose an insurance plan that offers out-of-network coverage. This means that the plan will reimburse you for a portion of the cost of seeing a therapist who is not in their network. The amount of reimbursement will vary based on your plan.

To find out if a plan offers out-of-network coverage, check with the insurance company or review the plan documents. You can also ask your therapist if they participate in any out-of-network panels.

Filing a Continuity of Care Appeal

If your new insurance plan does not offer out-of-network coverage or your therapist is not in their network, you can file a continuity of care appeal. This request asks the insurance company to grant you an exception and cover your therapist’s services, even though they are not in-network.

To file a continuity of care appeal, you will need to provide documentation from your therapist explaining why they believe it is medically necessary for you to continue seeing them. The insurance company will then review your request and make a decision.

Kaiser Permanente Considerations

Kaiser Permanente is known for its integrated system, where the insurance company and medical clinics are owned by the same organization. This means that Kaiser Permanente plans typically do not offer out-of-network coverage.

If your therapist is currently with Kaiser Permanente, you will likely need to choose a Kaiser Permanente plan if you want to continue seeing them. You should check with the insurance company to confirm this information.

Medicaid Considerations

If you are currently enrolled in Medicaid, you may be able to keep your therapist if your income continues to qualify you for coverage. However, Medicaid will become the secondary payer, meaning that your employer-sponsored insurance will pay first.

To determine your eligibility for Medicaid, contact your state’s Medicaid agency.

Conclusion

Navigating health insurance can be challenging, but it is important to remember that you have options when it comes to choosing a plan that meets your needs. By researching your options and understanding your rights, you can ensure that you can continue seeing the therapist who has been instrumental in your well-being.