So apparently mental health is not a necessary expense

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My SD goes to therapy. We have a bit of a copay with that which we use our HSA card for.

Today we get an email from the HSA company saying her therapy isn't a necessary expense and we have to provide a letter from her doctor saying it is medically necessary.

I don't know anyone who goes to therapy for shits and giggles.

And here you cannot even just go to a therapist. You have to get a referral from your doctor...who obviously wouldn't F***ing refer you to therapy if they didn't think it was necessary.

She's been in therapy for a long time and they are just now claiming this. Like why was it necessary last year but not this year? Same therapist, same reasons.

It's complete BS.
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Any specialist requires a refer from a doctor in order to be covered by insurance. There are lots of people who will reach out to a therapist independently without a referral. I understand that it’s annoying, but that’s just how insurance companies work, they can’t bill something that isn’t determined to be needed.
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RIZZY
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I bet that HSA would cover drugs for limp dick on a 50 year old man, though.
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Just go get the letter. And maybe ask her therapist exactly what that letter needs to say. Then ask the doctor to include it. Get her medical records while you’re at it. The counselor may need them. I know it sucks. But insurance companies are run by soulless unintelligent psychopaths that make the IRS seem kind, loving and competent. The sooner you learn that and how to play their game the better it is. My son’s counselor didn’t take insurance so it could be worse. I just paid out of pocket.
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RIZZY wrote: Tue Aug 02, 2022 10:44 am I bet that HSA would cover drugs for limp dick on a 50 year old man, though.
Drugs are cheaper than that 80 to 300 dollars a session once a week. I understand many kids need ADHD or anxiety medication. They have their place, I get that. So does counseling but why pay for that? That’s what the pills are for. Yes I’m cynical but I wouldn’t be surprised if insurances thought this way.
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Pjmm wrote: Tue Aug 02, 2022 11:23 am
RIZZY wrote: Tue Aug 02, 2022 10:44 am I bet that HSA would cover drugs for limp dick on a 50 year old man, though.
Drugs are cheaper than that 80 to 300 dollars a session once a week. I understand many kids need ADHD or anxiety medication. They have their place, I get that. So does counseling but why pay for that? That’s what the pills are for. Yes I’m cynical but I wouldn’t be surprised if insurances thought this way.
True dat. I wish they made a pill for teenage angst and rebellion.
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RIZZY wrote: Tue Aug 02, 2022 11:24 am
Pjmm wrote: Tue Aug 02, 2022 11:23 am
RIZZY wrote: Tue Aug 02, 2022 10:44 am I bet that HSA would cover drugs for limp dick on a 50 year old man, though.
Drugs are cheaper than that 80 to 300 dollars a session once a week. I understand many kids need ADHD or anxiety medication. They have their place, I get that. So does counseling but why pay for that? That’s what the pills are for. Yes I’m cynical but I wouldn’t be surprised if insurances thought this way.
True dat. I wish they made a pill for teenage angst and rebellion.
I think some rebellion is necessary. But yes it can have devastating consequences. As far as angst I thought the preteen years were worse. At least in boys. After thirteen mine started getting human again. Now what we need is a pill that will grow brain cells. I swear teens have one working neuron if they’re lucky.
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It depends on the type of insurance you have. EPO and PPO do not require a primary physician referral- at least not our insurance, for any specialist within network ( inner group, first or second tier).

Mental/behavioral health is covered by most insurances. The network may be limited, but it is covered. The terms of OP's coverage, or the network may have changed, if it is true that the insurance company is requesting a letter of medical necessity.

If her child has been with the same provider, getting a letter of medical necessity again and having it emailed or faxed to the insurance company should not be a problem.

Olioxenfree wrote: Tue Aug 02, 2022 10:43 am Any specialist requires a refer from a doctor in order to be covered by insurance. There are lots of people who will reach out to a therapist independently without a referral. I understand that it’s annoying, but that’s just how insurance companies work, they can’t bill something that isn’t determined to be needed.
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Olioxenfree wrote: Tue Aug 02, 2022 10:43 am Any specialist requires a refer from a doctor in order to be covered by insurance. There are lots of people who will reach out to a therapist independently without a referral. I understand that it’s annoying, but that’s just how insurance companies work, they can’t bill something that isn’t determined to be needed.
Mine didn’t…
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Olioxenfree wrote: Tue Aug 02, 2022 10:43 am Any specialist requires a refer from a doctor in order to be covered by insurance. There are lots of people who will reach out to a therapist independently without a referral. I understand that it’s annoying, but that’s just how insurance companies work, they can’t bill something that isn’t determined to be needed.
You would think so..however, my daughter did not need a referral to her therapist and insurance covers it with us having a co-pay of $75.

OP- I'm so sorry. I can only imagine the frustration. I would talk to her physician and ask for another letter with specifics to be given to the insurance company...maybe get the therapist to also write a letter on her behalf so that insurance will cover it. Therapy is not cheap and every little bit helps.
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