GETTING YOUR INSURANCE COMPANY TO PAY FOR EFFECTIVE OCD TREATMENT
(By Dr Fred Penzel)

Many individuals who suffer from OCD or have family members with OCD don’t realize that your insurance company is responsible for providing you with appropriate treatment by clinicians who are properly trained to treat Obsessive Compulsive Disorder. Professionals who specialize in OCD are unfortunately in extremely short supply and it is highly likely that you will not find a trained OCD specialist on your insurance company’s list of providers. Most specialists in the medical field no longer accept insurance plans and this is also true of most Obsessive Compulsive Disorder (OCD) specialists.

When Calling Your Insurance Provider

When you first call your insurance company to find out if any of the clinicians on their list treat OCD, they will likely give you several names and the representative may even reassure you that these individuals are OCD specialists. You can then move on and call the clinicians whose names they give you. When you speak with the therapist, it is important to obtain their credentials and ask what type of specific training they have received to treat OCD, as well how many individuals with OCD they have successfully treated. Ask them what type of methods they use to treat OCD (the answer should be Exposure and Response Prevention or ERP) and ask them to explain to you how this works. In the majority of cases, you will likely not receive the right answer and the professional may be a bit vague with you. Call each of the professionals they gave you, asking them the same questions. Visit our list of specific recommended questions. 

You may be lucky and one of the clinicians on their list will be qualified to treat OCD, but it is highly doubtful. More than likely, none of the insurance company’s professionals will have the training to treat Obsessive Compulsive Disorder effectively. You then call your insurance company again and explain to them that none of the clinicians they gave you is qualified to treat OCD and you and that you have found someone who has the qualifications to effectively treat OCD. If they become difficult, insist that under the terms of your contract they are required to provide you with appropriate care and they have no one on their list of providers that is qualified to treat you (or your child). Therefore, they must allow you to see a qualified professional that is out-of-network.

Keep Notes & Be Persistent

If the insurance company’s representative continues to resist, ask to speak with a supervisor and explain the situation once again. Let the supervisor know that you have already spoken with all of the professionals on their list and tell them that these clinicians weren’t qualified and didn’t know the appropriate treatment for OCD. Most insurance companies will now give in, however, some of the more stubborn companies may continue to resist and you may have to contact the state agency that regulates insurance companies.

When you begin this entire process, be sure to take notes of your conversations with the representatives and get their full name. Insurance companies are notorious for not remembering information given and forgetting the things they have promised. When communicating with insurance companies, don’t be intimidated. Be persistent and don’t take no for an answer. Remember that insurance companies are a for-profit business and they committed to paying out as little money as possible. However, you (or your child) are entitled to appropriate care by a qualified professional.

*Use this comprehensive list to gauge a professionals expertise in OCD treatment

Fred Penzel’s original article – “Fight for your rights”

Check Your Regular “Out-Of-Network Benefits”
*keep in mind you may be able to have OCD treatment covered additionally due to a lack of trained providers.

Insurance & Reimbursement

We do not directly bill insurance companies for mental health services, however your insurance may reimburse you for out-of-network services that we provide. Mentaya is a third-party service that helps our clients seek reimbursements from their insurance companies. You can use Mentaya’s benefits calculator to determine whether you may be eligible for out-of-network reimbursements for mental health services. Additionally, you will receive a detailed receipt with all necessary codes for out-of-network processing following each appointment via email, if you’d like to submit these receipts yourself for potential reimbursement.