Accessing Your Mental Health EAP & Insurance Benefits During COVID-19
What are EAP benefits?
When seeking services most people look for a therapist that may accept their insurance plan. Chances are that if you are employed, your employer has an EAP benefits line. EAP stands for Employee Assistance Program and typically provides assistance to employees to help resolve problems around stress, substance abuse, anxiety, depression and other mental health issues. Most programs are not just for the employee but also for their dependents, spouses and non-married spouses. Some EAP benefits may also include child/elder care, financial or legal problems, wellness apps and supports with workplace violence. These services are provided at no cost to the employee. EAP services are typically offered over phone, video, email, face-to-face or online chat.
How do I access my EAP benefits?
The first thing you need to do in order to access your benefits is to be employed by a company that offers services or have a spouse/significant other that has EAP services. When in doubt, call the benefits line and see. Once you decide that you are ready, contact your company’s EAP line or the benefits office of your company and inform them that you would like to use your benefits. They may ask you what type of issues you may need support with or if you have modality preferences to help narrow your search. Once you are given the list, you can interview the therapists you are interested in or that were given to you on the list of providers.
Pros of using EAP Benefits
The benefit to using the EAP services is that if you have never had counseling before you can test out counseling for the first time for free. I highly recommend using EAP benefits if it is your first-time seeking counseling or if you want to minimize your costs on medical expenses. In some cases, you can request a therapist that meet your preferences including someone who is bilingual, ethnic/cultural preference, specializes in EMDR, play therapy etc. If you do not like the session, you did not spend any money on services and can always go back to the drawing board. The next good thing is that you were able to take the leap at the expense of your employer. In some instances, you are granted 3-25 free sessions per year, which allows you to avoid having to use your insurance or requiring a medical diagnosis for claims to be processed. Most EAP programs require you to disclose symptoms like sadness, family problems or stress.
Before we jump into the financial part of insurance coverage, I would like to first extend another way to have benefits covered through your insurer. At this time, insurance companies are covering copayment and deductible costs. Some insurance companies have a disclaimer sharing that you have to have been impacted by COVID but in all honesty, we are all impacted by COVID including reduction in social activities, reduction of employment or work hours, increased parenting responsibilities etc. Again, not all insurance providers are following this trend but at the moment many are.
Like any other medical service behavioral health or counseling is included. When using your insurance benefits, I would recommend calling to get benefit information. When requesting benefit information, be sure to ask specific details about copay amounts, when will your services be covered at 100%, ask if behavioral health is covered at 100%, ask if you need a prior authorization before beginning services with a clinician and most importantly ask about having your copay or deductible covered due to being impacted by COVID. Most people who have a high deductible plan has to pay for their services at 100% until the deductible amount is met. Once the deductible is met, they will then be required to pay co-insurance or a percentage towards their service until their out of pocket annual is met. See example below for further explanation.
Other insurance plans include plans in which you don’t have to pay your total costs up front, but you are required to pay a copay amount. This copay amount will count towards your annual out of pocket costs, but you only spend money on your copay amount. This makes it easier for individuals to seek services on healthcare.
In any case in which you would prefer not to use your insurance benefits, you have the ability to use your HSA or FSA account to cover medical expenses including mental health services. FSA stands for Flexible spending account. HSA stands for health savings account. With an FSA or an HSA account, you put money into an account every pay period for medical or pharmaceutical expenses. Health savings accounts can be limited depending on your insurance selections. With limited FHA’s or HSA’s you can only use the account for allowed expenses. Some limited HSA expenses may include dental and vision only, meaning you can’t use it to cover other medical expenses. The best thing to do is to verify your FSA/HSA allowable expenses before indulging in services. The benefit of either account is that you have money set aside for all of your medical needs including counseling services. These accounts cover copays, deductibles elective surgery costs and emergency room costs. They are pre-tax deductions as well.
There is also an HRA or Health Reimbursed Arrangement. With the HRA, your employer puts money towards your health costs. Some HRA’s maintained by employers putting a monthly payment amount onto a card or healthcare account tax-free for you to use for medical purposes. This may not be an option for all medical plans offered by your employer, typically is seen with high deductible insurance plans to help alleviate the high deductibles you may incur for routine visits. Some of these accounts allow you to roll over funds from the year before and some require you to spend them by March 1 of the following year. If you do not spend the funds, you lost money. The luxury of these accounts is that you choose how much you put into them and I always recommend at least putting $500 away to cover an emergency room visit. On the other end I also recommend putting $1000 away in to cover routine visits, copay amounts, mental health sessions, medication, general dental costs and for eyewear or contacts.
Example 1 for Single Individual:
Calendar year deductible amount $1,500 for individual and $4,500 annual out of pocket maximum.
Callie has a counseling session and the cost is $120 per session. This year so far, she has spent $437 on office visits to her dermatologist. Callie has to pay for her counseling session up front because she has not met her $1,500 deductible for the year. She now has spent $557 toward her deductible and has $943 to go before her insurance begins to pay 80% towards her services.
Example 2 Family:
Calendar year deductible amount $3,000 and $12,000 annual out of pocket maximum.
John’s son has a $9,000 surgery. He was required to pay $3,000 of that plus 20% on the remaining amount because the deductible was met. 3000+ (6000x.20) = $4,200. They now have met their deductible but they still have to $7,800 before insurance will cover them at 100% meaning they do not have to spend another cent. The family had two more emergencies in that racked up a total of medical bills to $39,000, in which they were only required to pay 20% of the bill. 20% of the bill was $7,800. These incidents caused severe trauma and now the family is seeking counseling sessions for their youngest child. At this point, their counseling sessions will be covered at 100% until the remainder of the year.
Questions & Answers
What happens if I find a therapist that does not accept my EAP?
You can reach out to that particular therapist and ask if they are willing to get paneled with the EAP company your employer utilizes. This process can take anywhere from 14-90 days, if they are accepting new clinicians
What do I do when I run out of sessions?
Sometimes your EAP vendor may have the option of extending sessions or you may be able to continue with the therapist and use your insurance if they accept it.
What do I do if the EAP program does not have therapist that look or speak like me?
You can advocate for yourself and request that they recruit more licensed clinicians that can best support your needs culturally and linguistically
How does insurance work?
Depending on the type of plan you have you will either be required to pay a copay, coinsurance or a deductible when services are rendered. Your therapist will provide you with the required amount. In most instances, providers are required to provide insurance companies with diagnostic codes in order for your claim to be successfully processed.