How does insurance work?

 

Insurance companies operate by charging a monthly premium to all members, and broadly speaking, pay doctors using the money received from people who (mostly) don’t need to use services that year.  They negotiate with doctors and hospitals, keeping a lid on the price they can charge you for any type of visit or procedure.  Whatever money is left over, is their profit for that year.

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When you purchase insurance, either via an employer, or directly, there are a few key things to know:

 

1.  Do I have a DEDUCTIBLE?  This is a specific amount of money that must be paid in total (often across many different doctors and procedures), before health insurance benefits (or at least some of them) kick in.  Deductibles vary from a low of $250 to up to $5,000. If you have a 'Cadillac' plan, you may not have a deductible, at all.

 

Example: If you have a $2000 deductible, when you see your psychologist, you may have to pay the full fee (as set by your insurance company), as opposed to just a copay (unless this particular doctor visit is ‘not subject to the deductible’).   NOTE: Insurance companies sign contracts with all doctors (and hospitals), which limit how much any type of visit or procedure can cost.  If you didn’t use your insurance benefits, the doctor/hospital could theoretically charge anything they wanted.  They are not allowed to charge more than what your insurance company has said they can, by their contract.

 

After seeing many different doctors and having a variety of procedures once the total amount of money you’ve spent reaches $2000, from now on all you have to do is pay the copay (a fixed smaller amount)  or sometimes the ‘co-insurance’ (which is based on a percentage of the fee).  However, some types of visits are not ‘subject’ to the deductible (see below for what this means).

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2.  What is my co-pay/Co-insurance?  Copays/Coinsurance are a smaller amount than the maximum that is allowed to be charged by your doctor, that you, the health insurance consumer, usually pay for a doctor visit.  They range from a low of $5 to a high of $75.  Some ‘Cadillac’ plans have zero co-pays (a relative rarity nowadays).

 

Note: Some insurance plans designate certain type of doctor visit copays as ‘not subject to the deductible.’ This means that even if you have a deductible, and even if you meet it, you will usually still have to pay this copay, for most visits (until you meet your ‘Out of Pocket Maximum’).

 

3.  What is an Out of Pocket Maximum (OOP)?  Every health insurance plan has a maximum amount that you are at risk for spending on doctors/procedures for the entire year. 

 

For example: If you have an OOP of $6000, after spending $6000 for any and all health insurance visits and procedures (for that year), including all co-pays (even those ‘not subject to the deductible), at that point ALL your visits and ALL your procedures are covered 100% by the insurance company. In plain words: You won’t have to spend a dime on any more doctor visits or medical procedures, once you’ve reached your OOP.

 

However, please note that all the above applies to doctor visits, procedures and labs.  There are often deductibles and copays for prescriptions, separate from this.

 

          

Common Questions about Psychologists and Psychotherapy

 

What is a psychologist?

Psychologists are more accurately called ‘behavioral scientists.’ They receive doctoral level training in the science of what people can do in order to (a) Change unwanted behaviors (b) Improve one’s emotional states.  They receive extensive training in classical behavioral conditioning, operant conditioning, biology, neurology, neurochemistry, pharmacotherapy (though only a few states at present allow them to prescribe).  Psychologists are the only licensed professional trained in and allowed to administer IQ and personality tests.  Psychiatrists (who are medical doctors and receive traditional medical school training), tend to limit their practices to prescribing psychotropic medications, such as Prozac and Xanax, as opposed to providing psychotherapy. 

 

If you have a PhD in Psychology, are you then a ‘Psychologist’?

 

In short, No.  In California, you can only be called a ‘psychologist’ if you have BOTH a PhD or PsyD AND have passed the licensing exams for psychology.  There are many people with PhDs in psychology who are NOT “psychologists.”

 

Who goes to see a psychologist?

 

When you go to a psychologist, it’s usually because your emotions and/or behaviors, are not what you generally want them to be and despite your own attempts to change, haven’t had much or lasting success.  You might be feeling chronically sad, anxious, angry, or are using alcohol/drugs too frequently.  You might be having chronic arguments with friends, family or your spouse.  You might notice that friends are not calling, or that you are feeling lonely.  Sleep might be disturbed because of insomnia caused by high levels of anxiety or depression.  You may have experienced violence or some form of trauma, and can’t seem to let go of it, and move on.  Bottom line: Any kind of feeling/emotion or chronic behavior that you find distressing or painful, and would like it to stop, is why people come to see psychologists.

 

People also come to see psychologists for what is called ‘testing and assessment.’ This includes things like personality evaluations (for example, to be a police officer) as well as intellectual and learning/educational evaluations for children and students, as well.

 

What is psychotherapy, exactly?

 

A detailed answer to this question would fill a book (and has filled many).  However, let’s put it in a nutshell:  When you arrive at most psychologist’s offices, you will be asked to sit down in front of him/her.  Through a gentle process of discussion, dialogue, and asking questions, the psychologist will gather information about your behaviors, your past and present, your beliefs about yourself and the world around you.  Through this process the psychologist is eventually able to identify the beliefs, environmental factors, or neurological/medical or physiological factors, that are driving your emotions and behaviors.  The process itself is often healing, as painful experiences and memories are frequently discussed for the first time, in the presence of a non-judgmental, supportive and encouraging adult.  Crying in-and-of-itself has been scientifically demonstrated to have healing effects.  Often (if appropriate) the psychologist will suggest options and possible solutions to difficult personal life circumstances.  New daily routines might be encouraged, such as meditation, and exercise.

 

There are a variety of methods, some of which are called ‘evidence based’ (tested rigorously via scientific methods and shown to objectively bring about emotional and behavioral change).  These approaches almost all involve helping one to:

 

• Develop greater awareness of one’s thoughts (and other factors, such as neurology, genetics, nutrition, and physiological factors) that are driving emotions and behaviors.

 

• Discuss experiences/memories that have been painful and/or traumatic in order to help vent and eventually develop an understanding about the experience that allows one to no longer feel threatened or as affected by the experience.

 

Original psychotherapy, as developed by Sigmund Freud in the 1880’s, was based on personal observations and early theories about human developmental processes.  Some of Freud's hypotheses have been validated and some not, but his foundational premise that people are driven by forces they are not aware of, has been validated repeatedly.  Because Freudian psychotherapy was THE form of treatment for nearly a half century before any kind of controlled scientific testing of psychotherapy began, it persists as the most well known approach (lying on a coach, facing away from the psychologist, expressing oneself through a “stream of consciousness”).   However, the vast majority of modern psychotherapy occurs with the psychologist and client sitting and facing each other.  The benefits of not facing the psychologist do help some people feel more relaxed, and talk with greater ease about painful, uncomfortable topics.  But that is now a much less frequently used physical arrangement.