OCD and Health Insurance

by vectorolie at freedigitalphotos.net

by vectorolie at freedigitalphotos.net

Nothing about obsessive-compulsive disorder is easy. If you or a loved one suffer from OCD, you likely know what I mean. Aside from having to deal with the actual symptoms of the disorder, you also have to work on getting the proper diagnosis, understanding what OCD really is, perhaps learning how to not enable your loved one with the disorder, and finding the right treatment. Achieving each one of these objectives is a major accomplishment.

Let’s say you’ve completed all these stepping-stones toward your goal of recovery and you’ve either found a great therapist, or at least know what type of therapy you or your loved one needs.

How are you going to pay for it?

Many of us cannot afford to pay for medical treatment without health insurance. I’ve previously written about the advantages of living near a large research university and the possibility of receiving free treatment there. What I’d like to touch upon today, however, is how to get what you rightfully deserve from your  own health insurance company.

Dr. Fred Penzel has written a gem of an article on this topic. I highly recommend reading it even if it’s not relevant to your current situation. The information he provides, while specifically meant for those seeking treatment for OCD, can be useful when dealing with other illnesses as well.

Here, in my opinion, is one of the most important things Dr. Penzel has to say:

There is a little secret that your insurance doesn’t want you to know about. The rules say that your company is responsible for providing you with adequate treatment by properly trained practitioners. 

This is something my family dealt with at one point when trying to find a good therapist for Dan. Our insurance company gave us a list of psychologists and social workers who were “qualified” to treat OCD. After calling each and every one of them on the list, it was clear to me that not one of them specialized in treating OCD. Some of them had never even heard of exposure and response prevention (ERP) therapy.

Try explaining that to the insurance company: that their qualified mental health professionals really aren’t qualified after all. As I said at the beginning of this post, nothing pertaining to OCD is easy. But Dr. Penzel walks us through exactly what needs to be done to get the proper treatment we deserve. And by proper treatment, I mean a competent, experienced therapist who is trained in exposure and response prevention (ERP) therapy, whether they are “in-network” or not.

In our own case, I did end up finding a wonderful therapist who wasn’t on “the list” but fortunately was an in-network provider. He was my son’s therapist for over three years, and I’m grateful that we did not end up having to fight for Dan to see him.

In his article, Dr. Penzel reminds us that our insurance companies aren’t doing us any favors or bending over backwards for us when we insist on what is rightly ours and they actually comply. We pay good money for our benefits, and as much as these for-profit companies might try to tell us otherwise, they are legally required to pay for proper care.

Of course, this brings up another issue: the shortage of proper care. Sigh. As I said, nothing about OCD is easy.










This entry was posted in Mental Health, OCD and tagged , , , , , , , . Bookmark the permalink.

14 Responses to OCD and Health Insurance

  1. Thanks for pointing us to the article. I have insurance now, but when I was first diagnosed, I was in my 20s and in the middle of 8 years that I went without health insurance. It was a struggle to get treatment and pay for my medicine. Community Services, which provides lower cost mental health services in Virginia, helped with some counseling, but you had to take what you could get–not necessarily experts in what you needed. So many changes are needed in our MH system in this country.

  2. diana-keller@comcast.net says:

    Very intersting information. Many thanks for posting this!  A big issue here in Massachusetts is that the best providers often do not take insurance.  So that means patients must pay the bill in full and then submit claims directly to BC/BS.  The reimbursement levelback to the patient  is then not PCP directed and the claim level of reimbursement is lower.  For those financially stable patients with the means to pay, it is only a minor annoyance.  But, it prevents patients with less means from getting the best care available.

    • Thanks for this information, Diana, and I know it’s true that many of the best treatment providers for OCD do not accept insurance. Our family also went through the process of having to submit our own claims at one point. You are so right that it prevents people who need good care from getting it. Thanks again for your insight.

  3. katherine querard says:

    I ifound this very very helpful and it came right at the point where i was ready to throw in the towel with blue shield CA. But, instead, i read the article by the doctor (which pretty much described our exact situation to the T!) and then used the exact language he suggested. It took over an hour on the phone and a refusal to accept the only thing offered – “an apology” – but, in the end, we prevailed. Out of network therapist and psychiatrists now covered at their rates, not those suggested by Blue Shield.

  4. 71 & Sunny says:

    Oh this is hard stuff. People first have to know what the problem actually is, then they have to find a qualified treatment provider (good luck) and then be able to pay for it. Awareness, access, and affordability. Three tough things. I can’t tell you how many people I’ve spoken to that can’t afford proper treatment. I mean, what do you say to them? Sigh.

    • I know, Sunny. I share your frustration. I sometimes suggest self-help workbooks, but they really don’t replace a competent therapist. It’s so unacceptable that people who want help can’t get it. Thanks for your comment.

  5. madblog says:

    We are finding a different problem here (Philadelphia): lots of practitioners but none of them accept insurance. None. At all. I haven’t discovered why; the only response so far is that it’s just too expensive to practice–insurance doesn’t cover the Dr.’s expenses?
    Our household has several sufferers and it is extremely disheartening to know that we cannot help them. Right now the (fortunately only) one in crisis is going for treatment while we wait for some reimbursement. It’s breaking us.

    • Thanks so much for sharing, and your story is heartbreaking, and I believe, all too common. From what I understand, many mental health care workers say they cannot afford to accept the lower rates mandated by insurance companies, so they opt not to participate in those plans. Also, I have heard the paper work is horrendous as well. If there are any practitioners out there who could shed some light on this subject, it would be much appreciated. Meanwhile, that doesn’t help your family, madblog. There’s got to be a better way!!

  6. Mary says:

    Pretty much the same here in Arizona. When finding a therapist for my son it took several weeks – the recommendations provided by his insurance co. were no help. I called each and every therapist and indeed some did not know what ERP was/is, or they did not specialize in OCD. I finally found a therapist who is out-of-network and specializes in OCD, and incorporates ERP. Thankfully the insurance company somewhat reimburses, but in my course of research I found that ALL of the therapists/doctors in the Phoenix area who are specializing in anything and especially OCD are all out-of-network and don’t accept insurance plans at all. Just to see a psychiatrist recommended by the therapist for med evaluation was $550.00 for the initial evaluation and of course he did not accept any insurance plans. Needless to say we did not go, and found an alternative through my son’s PCP. Indeed the system is outlandish if that’s what it is – a healthcare system? After going thru this I have my doubts. I feel as others do this is breaking us. If OCD were breast cancer or even ALS, no doubt we wouldn’t be having this conversation or at least it would be minimal. Perhaps we need an ice bucket challenge for OCD?

    • I agree with everything you say, Mary, and share your frustration. We certainly need more understanding and awareness of OCD and its proper treatment…….the “system” is not working as is, and people are suffering needlessly.

  7. Anthony says:

    I agree as I was lucky in finding an in network therapist who understands the type of treatment needed for OCD. That’s not common unfortunately and insurance companies should be paying for your care. I do want someone closer to me as I have moved further away from my therapist. But, that means finding an unqualified therapist or going to an OCD specialist who may not be able to negotiate a rate with my insurance.

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