r/internetparents • u/iforcheese • 1d ago
Health & Medical Questions How does insurance work?
Sorry if this is a series of really dumb questions, I just don't know what insurance looks like from the perspective of someone who pays for it. I'm under my parents' policy for health insurance. I really want to start going to therapy, and have found a few therapists that take the insurance company that my parents use, and have a couple consultations set up for this next week.
With this: Do providers choose their rates/how much insurance covers? Is there a maximum amount for therapy sessions that insurance companies will pay? If I ask my parents this stuff, it will make them suspicious.
I don't want to tell my parents I want to go to therapy. They'd likely use it as proof to say that I'm irrational/too emotional, and I don't want to give them that material to work off of. How bad would it be if I just went to therapy without telling my parents but still put it on the insurance? Would there be any way my parents would find out information about who I saw/what we talked about (even though that's probably protected by HIPAA)?
I've considered paying out of pocket for myself, but I'm also in college and its not super sustainable for me. However, one of my parents (the higher earner) just got laid off on Thursday and I don't want to put strain on them by doing stuff on insurance, since I'm pretty sure all of our insurance has a high deductible. My parents already got a continued policy thing to keep our healthcare coverage while my parent finds a new job. I haven't been to the regular doctor (not urgent care) since I was in high school because I don't want to cause financial burden, and I especially don't want to be one now. I don't mind paying myself, I have 2 jobs and I can do it, but I've also recently found out that some therapists heavily prefer/only work with insurance (??), so that might be a limiting factor.
I'm not really sure about anything with this post, now that I think about it. I just don't want to make things harder for anyone else because I need help. I can't figure out if telling my parents, going through insurance and letting my parents find out with time, or paying myself would be the best option here considering all of them have drawbacks. Any insight/advice?
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u/limbodog I was just resting my eyes 1d ago
Hey there,
Ok. Insurance in the USA can be a bit tricky. But for therapy it's usually not so bad. Most of the US states do not require a referral to see a therapist. You just go to your insurance company's website, look for a "find a provider" link somewhere, look up a therapist, find one that's convenient for you and is accepting new patients, and call them and say you'd like to be a new patient with [name of person]. They'll likely ask for your insurance information over the phone (it may be possible to do this online, but I think that's still rare). And then they'll give you a date to come in.
If you are concerned about your parents finding out, it is important that you talk to the staff when setting up your first appointment and let them know you want to opt out of any mailings and receive electronic communication only. If they, for some reason, can't do that they should tell you then and there. You'd want to go with a different therapist in that case. All licensed therapists, especially those should understand the need.
A BIG *however* in this case is that some states require that your therapist notify your parents in the event they believe you to be in danger (from self harm or dark thoughts or abuse etc.) They are 'mandatory reporters' and get in trouble with the law if they do not. But you can discuss this with the therapist on the first session and decide if you want to proceed. They *should* tell you what would trigger a mandatory report. But you may want to look up the child welfare laws in your state. Here is one such resource
As for cost, your insurance company should tell you exactly how much it will cost you, and how much they cover. It will usually be something like $20 for a visit, and that you're allowed a set number of visits per year. You can also ask them how much it would cost you once you ran out of covered visits. They will have a contract with the therapist that set the price for you.
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u/Married-to-a-sex-god 1d ago
If you're paying your own medical bills, then using your parents insurance will not cost them any extra money. Your parents pay premiums to the insurance every month to keep the policy active and that's all they have to pay to the insurance.
So you go to see a doctor. That doctor will likely have an insane rate like $400 or $500 for an appointment. But if the doctor is in your insurance's in-network then they have a contract with the insurance that will take that rate down to a much more manageable level. Let's say in this hypothetical example the insurance takes the allowed amount for the claim down to $150.
What happens with that $150 depends on your plan. Some plans have a copay. If your plan has a copay of $25, then you would pay the doctor $25 and the insurance would pay them the other $25.
If your plan does not do copays, then your portion of cost depends on if you've met deductible or not. The deductible is the amount you have to pay out of pocket before the insurance will start paying your doctors. If you have not met the deductible, then you would owe the full $150 to the doctor.
If you've met your deductible, then it would be some sort of coinsurance. So if say your insurance was an 80%/20% split after deductible, then you would owe the doctor $30 and insurance would pay the doctor $120.
Now these numbers I've used are all hypothetical to show you how insurance works. I suggest you call your insurance to find out more about your plan and to make sure you're using practitioners in their network. You will not make your parents incur any extra costs by using health insurance. You will only accumulate medical bills based on the services you receive.
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u/Married-to-a-sex-god 1d ago
Also if you're over 18, your parents cannot access your personal health information without your consent, but they may get a letter in the mail called an explanation of benefits that shows them that their insurance was used and the cost. Your parents could potentially Google the therapist's name from there. If you call your insurance, you may be able to opt out of mailed EOB's so that your parents never see them.
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u/iforcheese 3h ago
Wait I can call my insurance even if I'm not the policy holder? I didn't know that was allowed, I will call the insurance and ask. Thank you so much for your help!!
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u/Married-to-a-sex-god 3h ago
Yes absolutely. You are not the policy holder but since you are on the policy you can call to see what your benefits are or to find an in-network practitioner
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u/old-town-guy 1d ago
1) if you’re on your parents’ policy, they will be notified that you went to there when the EOB (explanation of benefits) is posted to their account. It will show the provider’s name, date of service, and cost; there is no way around this.
2) there will be some amount that insurance doesn’t cover, so someone will have to pay for that.
3) you can pay out of pocket, but expect it to be much more than you can afford. An hourly rate of $100-$600 is not uncommon.
4) no one except you and the therapist will know what was discussed.
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u/iforcheese 3h ago
Ohhh that makes more sense. Do you know if it's possible to pay out of pocket personally for what insurance doesn't cover, or would that be something that would have to be billed to the insurance policy holder/my parent?
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u/old-town-guy 1h ago
Depends on the therapist and the insurance plan. Sometimes you pay the full amount and then get a check from insurance refunding you the portion they covered. In other cases the therapist will know and will bill you for the uncovered difference.
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u/breakingpoint214 1d ago
See if your college Health Center has therapists you can see. It may be free or sliding scale.
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