TLDR: Open enrollment is a window of time each year when you can change insurance plans. For most people, it is approximately November through January. If you have access to different plan options, switching to an insurance plan that is a PPO PPO (rather than an HMO which will not pay for out of network therapy) and that maximizes coverage of out of network claims will help you receive the most money possible toward private pay therapy.
If you’ve ever searched for a therapist who is just the right fit, then you know it can be really hard to find someone who is both the right fit and also in your insurance network. There are many reasons for this, but the main two are that insurance companies do not pay a livable wage in many areas (especially Los Angeles and the South Bay), and they also place limits on care that prioritize profit for the insurance company over the client’s best interest. This is why private pay therapy often (but not necessarily) means higher quality care.
Everyone deserves access to high quality therapy to improve their wellbeing. Our system is broken, and that’s not your fault or the fault of any given therapist.
There are a variety of ways to make it more affordable, including using your insurance to pay for part of the cost.
But since it’s November, this post specifically discusses how to take advantage of open enrollment season to maximize what insurance will pay you toward the cost of private pay (or out of network) therapy.
What is open enrollment season?
Open enrollment is a designated time each year where you are able to change insurance plans without a Qualifying Life Event (QLE) such as marriage, having a baby, or changing jobs. It varies depending on the company and state, but usually occurs in fall or winter (but not always).
How can open enrollment help me pay for therapy?
During open enrollment, you may be able to change to an insurance plan that will reimburse you for part of the cost of private pay therapy. You may also be able to change to a plan that covers more of the cost if you already have a plan that covers some of it.
PPO insurance plans will reimburse you for part of the expense of healthcare from providers who are not in network, after you have paid your deductible. HMO plans will not.
If you have access to a PPO plan as an option, changing to a PPO plan from an HMO or EPO plan will allow you to submit out of network claims to get part of the cost of private pay therapy reimbursed.
If you have access to multiple types of PPO plans, if you choose one that has a lower deductible and covers a greater percentage of the cost of out of network claims, it will cover more of the cost of private pay therapy compared to a plan with a high deductible or that only covers a low percentage of the cost.
These types of plans are more expensive, but if you know you are going to access a lot of out of network services, you can still come out ahead. Sometimes even far ahead! You will have to crunch the numbers for your specific situation.
Whether you are looking at different plans through the Affordable Care Act or your employer, all plans will have documents outlining what they cover. Study these to learn what each plan will cover and call the insurance company if you have any questions.
How do I submit out of network claims to a PPO insurance plan?
Call your insurance company to ask what they cover and what their specific process is. Follow the instructions in my post, How to Get Insurance to Pay For Therapy.
What other strategies can I use to make out of network (private pay) therapy more affordable?
You can also take advantage of Flexible Spending Accounts (FSA) or Health Savings Accounts (HSA), as well as deduct therapy as an expense during tax time. There are also directories for low-cost therapy services. Learn more in my post How to Get Insurance to Pay For Therapy.
Start Therapy for Women in Los Angeles:
If you feel like you’re both too much and not enough, feeling overwhelmed with too much on your plate, or struggling in relationships or self-esteem, working with a therapist who specializes in women’s issues and experiences can really help. Start by following these steps:
Reach out for a consultation at Well Woman Psychology.
Meet with a therapist specializing in women’s issues.
Start practicing effective strategies to feel better.
About the Author:
Dr. Linda Baggett is a licensed psychologist and founder of Well Woman Psychology, a virtual trauma-informed and weight inclusive therapy practice specializing in women in California, Colorado, Illinois, New York, and Washington. Dr. Baggett helps women cope with trauma, anxiety and relationship challenges so they can build the life they want and release what is no longer serving them. She also supports clients with body image, relationship issues, perimenopause and menopause, perinatal and postpartum challenges, pregnancy loss and miscarriage, and infertility.
Disclaimer: This blog is for educational and informational purposes only, is not a substitute for individual medical or mental health advice, and does not constitute a client-therapist relationship.