The 21st century has been a time of choice. We can choose our school. We can choose our job. We can choose how we use social media. We can choose what we want for breakfast, and we can choose if we want breakfast for dinner.
What many don’t realize is that we can also choose our health insurance benefits. During a period called open enrollment, we sign up for the health insurance plans that best suit our needs and our family’s needs.
For those of us with OCD or who have loved ones with the condition, one of the most important decisions we might make is to choose a plan that either covers Exposure and Response Prevention (ERP) therapy – the gold-standard behavioral therapy for OCD which NOCD Therapists specialize in – or to decide to go with a plan that offers strong out-of-network benefits.
Yet, I hear from people every day whose health insurance does not cover evidence-based, effective, affordable OCD treatment. If you are in this situation, there are three actions that you may be able to take to get the care that you deserve. I’ve learned about these options from the incredibly resilient members of the NOCD community:
Be Your Own Advocate: Speak Directly With Your Employer’s HR Team
One of the simplest, yet influential steps you can take at work is to go to the head or leaders of your Human Resources (HR) department and tell your story, your child’s story, or your family’s story. By advocating for yourself and those you love, you’re letting the HR team know there are unmet needs for not only you, but also others like you in the community. If your employer’s health plan doesn’t offer coverage for ERP therapy today, ask them how they might be able to help you mitigate the issue or whether there are out-of-network assistance programs.
The reason this can help you and others with OCD is that you are educating your HR department on how serious OCD care is, and your personal story will help them better relate to the magnitude. Having your voice heard by your HR representative and the office of the Chief Human Resource Officer (CHRO) or equivalent is how you can support raising the awareness for OCD. This increases the chance that your employer will consider making changes in health insurance benefits to include the right care for OCD.
Health insurance companies make a large percentage of their earnings by working directly with employers. Sometimes these employers are large and called “self-funded employers” or “Administrative-Services Only” (ASO) employers. Other times they are smaller and called “fully-insured employees.” Given the employer is the client, large health insurance companies often listen directly to their client’s needs – and by educating your employer, this should include your needs.
Using Alternative Payment Options: Submitting Superbills or Single Case Agreements (SCA)
Depending on your plan, you might be eligible for out-of-network benefits. Services that are out-of-network might be eligible for some coverage if you submit a superbill to your insurer. A superbill is similar to a receipt for your therapy sessions – it’s an itemized form used by healthcare providers that details services provided to a patient. Superbills are used to create a healthcare claim, which will be submitted to payers for reimbursement.
Another option that can be helpful in paying for therapy is submitting paperwork for a Single Case Agreement, or SCA. An SCA is an agreement between your insurance company and a provider you are out of network with that allows you to be treated as in-network for a specified amount of time. This is handled on a case-by-case basis.
Evaluate Health Plan Options: Year over Year Health Coverage Is Not Always The Same and Different Plans Offer Different Coverage
If neither of the options above work for you, you could look into whether your employer offers multiple insurance plans for your consideration; for example, your employer may offer both Optum and Blue Cross Blue Shield plans. It is important to consider all of your health plan options during enrollment, as plan costs and in-network providers change year-over-year.
To compare plan costs, there are usually cost comparison tools available for your use at the time of enrollment. In addition to considering the plan costs, also use the provider directory to make sure the providers you want are listed as in-network. Finding a balance between costs and availability of the providers you want to use is critical in having the insurance coverage that is best for your needs.
For those without employer-sponsored health insurance, enrolling in a plan on the open market might be an option to consider. Often employers that are not offering coverage can have services that help their employees with navigating the state-based insurance exchange.
Need Help? Reach out to NOCD
As a team of people with OCD and those who treat it, we want this crisis to end. It will only happen if our community of people with OCD becomes more informed, since OCD is manageable for many, but effective therapy isn’t readily accessible for everyone. We are working to change that. Our community can be the loudest 5% in the room, making positive change for the rest of the 95% and ensuring that all behavioral health networks consist of high-quality treatment options. If you have more questions, please don’t hesitate to contact us at email@example.com.
Additionally, if you’d like to access ERP therapy services through our network of licensed therapists that specialize in OCD and related conditions (including BFRBs, Hoarding, Tic Disorder, Anxiety, Depression, etc), don’t hesitate to book a free 15-minute call with our team or to check out our therapist directory.
We provide affordable options for treatment and accept many insurance plans, including UnitedHealthcare, Cigna, Humana, many Blue Cross Blue Shield plans, and more. If your plan is out-of-network, we may be able to help you submit an SCA to your insurer (contact us at firstname.lastname@example.org for eligibility and details). If you can’t get coverage, we will help you draft a letter to your Head of HR, if that’s something that interests you.