Counselling Psychology Benefit Coverage

Taking care of our mental health is vital for overall well-being, and having access to adequate psychological support is essential in achieving a balanced and fulfilling life. In Alberta, Canada, various benefit coverage options exist to help individuals access mental health services and treatments, providing much-needed support during challenging times.

In this post, we will delve into the particulars of psychology benefit coverage in Alberta, exploring the different types of coverage available, eligibility criteria, covered services, and the various pathways to accessing mental health support. Understanding how benefit coverage works is crucial for making informed decisions about our mental health care, ensuring that we can access the services we need when we need them.

Psychology Benefit Coverage in Alberta

While Canadians have access to universal publicly funded healthcare, not all types of clinicians and treatments are funded. Furthermore, the landscape of funding in healthcare tends to be politically controversial and frequently changing.

Mental health services can be provided by different types of clinicians and in different settings. It is the clinician and setting that determine if the service is publicly funded or paid ‘out of pocket’. Mental health clinicians include psychologists, psychiatrists, social workers, counsellors, family doctors, nurse practitioners, and psychiatric nurses to name a few! Treatment settings can include hospitals and public outpatient clinics; non-profit organizations; and private businesses.

Types of Alberta Mental Health Insurance

Public Health Insurance (Alberta Health Care)

Your Alberta Health Care coverage generally covers mental health treatment that occurs in Alberta Health Services operated hospitals and outpatient clinics, as well as services provided by a medical doctor such as a family doctor or psychiatrist that can bill to Alberta Health. In Alberta, some Primary Care Networks also provide mental health services which are funded. Non-profit organizations can also provide low or no-cost mental health services, though not operated through Alberta Health and access various funding models.

Workplace Benefit Plans

Many clients that access psychologists in private practice use workplace health benefits. That is, the client (or their family member’s) workplace offers extended health benefits coverage for which they have enrolled. This typically includes medication coverage and dental, and many plans also have coverage for other treatment types such as psychology services, occupational therapy, vision, physiotherapy, speech-language therapy, and so on. Common examples of extended health benefit companies include: Alberta Blue Cross, Canada Life, Manulife, Sunlife, ect.

Government and other Programs

Some programs provided through the government and other organizations offer individuals extended health benefits. Examples of these programs include: First Nations, Metis, and Inuit Non-Insured Health Benefits, Veterans Affairs Canada, Alberta Workers’ Compensation Board, and others. If you have coverage through a program such as these, you may have access to counselling supports paid for through the program (ie. a set number of counselling sessions).

Understanding Your Counselling Benefits Insurance Coverage

Workplace Extended Health Benefits: What’s My Coverage

So you have extended health benefit coverage- now what? If you believe you may have extended health benefit coverage here is a list of steps to take in understanding your insurance coverage.

1.  Find out who the insurance provider is (e.g. Alberta Blue Cross, Canada Life, ect.). If you are not sure, you may need to ask your employer or contact HR. Often insurance coverage booklets or insurance online member portals explaining coverage are provided to employees.

2. See if your coverage includes psychological services and/or counselling. All benefit plans are unique, so you need to see what your specific plan offers. Note that psychology and/or counselling services may be referred to under “extended health” or “paramedical providers”

3. If your benefits do include psychology and/or counselling services, the next step is to find out your coverage limits. Coverage limits are typically a yearly amount that can be used on the service such as $500 per year to $2500 or more per year. Many plans are set to have the coverage limit renew in January, but it is also good to find out the details of your specific plan.

4. Find out what amount is covered per visit. Some plans will cover up to a certain dollar amount per session (e.g. $150 per session) or cover a certain percentage amount of a session (e.g. 80% per session). The amount not covered by the insurance benefit coverage is paid by the client, called a copay.

5. Lastly, you will also want to confirm the types of treatment and clinicians that the plan covers. For example, does the insurance cover both in-person and online sessions? Can you use your coverage towards individual therapy as well as couple’s, family, or group therapy? What are the therapist credentials the plan covers?

An example of coverage could sound like: Bob’s Alberta Green Circle plan includes 100 percent coverage up to $1200 per year towards any format of counselling services provided by a psychologist or master’s level social worker.

Considerations in Selecting a Mental Health Therapy Clinic

Mental Health Therapist Credentials

Each plans specifies the type of mental health provider they allow. Psychologists are almost always covered for psychology services. Provisional psychologists and master’s level social workers may be covered, depending on the plan. Counsellors are less frequently covered, but may be, again depending on the plan. If you would like to use your benefit coverage, make sure your therapist’s credentials align with the credentials covered by your insurance prior to starting.

Clinic Billing Processes

Direct billing is a term that means the office or clinic you attend bills the insurance provider directly rather than you paying the clinic and being reimbursed from the insurance company. In keeping with our theme of ‘it depends on the plan’ some insurance companies allow direct billing, some do not, and some depend on the specific plan. Some clients prefer to find a therapy clinic that can direct bill to the insurance company so the client does not have to wait to be reimbursed through insurance.

Additional Mental Health Counselling Insurance Details

Multiple Insurance Plans

Sometimes clients will have more than one extended health benefit coverage. There are very specific rules in how this type of billing occurs, which is termed ‘coordination of benefits’. This means that one of the insurance provider companies must be billed first, called ‘primary insurance’ and the other must be billed second, the ‘secondary insurance’. For example, if you have your own workplace coverage and are also enrolled in your spouse’s plan, your workplace coverage is the ‘primary insurance’ and billed first, and any remaining balance can then be submitted to the ‘secondary insurance’. Generally speaking, mental health therapy clinics cannot direct bill most coordination of benefits. If you are unsure about the process, ask your clinic or call your insurance provider.

Confidentiality

With workplace benefits, your personal health information is confidential and not released to the benefit provider with the exception of billing. If you have consented to direct billing, the clinic would be releasing the details found on an invoice (ie. your name and policy details, the service type such as in-person counselling, the session length, and the cost).

Coverage under the section of above titled ‘Government and Other Programs’ may also require reporting for coverage to begin or for an extension. If reporting to the program is required, this is a conversation you and your therapist have prior to information being released and with your written consent, unless governed by other legislation. It is always best to clarify with your clinician and program if you are unsure or have concerns.

Deciding Which Counselling Route To Take

Benefits of Public Mental Health Counselling

If you are seeking counselling and do not have group or employer extended health benefits that cover counselling, accessing supports through Alberta Health Services, Primary Care Network, or a non-profit organization is a great option. Public and non-profit mental health organizations may also be more flexible with the cancellation and no show policy than in private practices.

Drawbacks of Public Mental Health Counselling

Potential drawbacks of accessing supports through Alberta Health Services, a Primary Care Network, or a non-profit organization is the potential for longer waitlist times. These organizations may also have a limited number of sessions offered (such as 6 or 12 sessions) to each client to ensure that those on the waitlist can also access supports. Lastly, public mental health may have specific criteria for clients to access services (ie. based on age, doctor referral, or presenting concern).

Benefits of Private Mental Health Counselling

Counselling in private practice typically offers more timely access to services, often clients can self-refer rather than requiring a referral through their doctor, and generally have more choice in the type of services they are seeking (ie. they can choose the therapist or type of treatment approach they would prefer). If you decide that you would like to try a different therapist or clinic, you are free to select the service of your choosing from more options available.

Drawbacks of Private Mental Health Counselling

In private practice settings, counselling is paid to the clinic either directly by the client or the client’s insurance. If the client does not have insurance coverage or the financial resources, the client’s ability to access services may be limited in frequency or duration. Private practice counselling settings may also be more strict on cancellations and no show policies, and likely charge fees for cancelled or missed sessions. Some private practice settings do offer sliding scale session fees, however these may be limited.

The Route Outcome?

Deciding to choose public or private mental health counselling tends to be a matter of coverage and access. If you have extended health benefit coverage for psychology services or if financial resources are not a barrier, opting for a private clinic may be a good place to start and may help to lower the demand on the public system. Conversely, if you do not have coverage or have limited coverage and/or limited financial resources, beginning with access through public organizations may be a good option. Having worked in both settings, I can absolutely endorse that there are very compassionate and hardworking clinicians, providing excellent mental health counselling, available in both public and private practice. Of course, if you find that the clinician you are working with is not a fit for you, it is worthwhile to explore switching therapists.