High Deductible Health Plan for Therapy Clients: 6 Easy Tips

A high deductible health plan for therapy clients means the client pays more out of pocket before the plan starts to pay. HealthCare.gov describes a high deductible health plan as a plan with a higher deductible than a traditional plan, usually with a lower monthly premium, and says it can be combined with a health savings account.

This guide covers commercial plans, which are private payers. Medicare and Medicaid follow different rules, so check those separately. It is written for therapists and psychiatrists.

What a high deductible health plan changes for a therapy practice

Many clients choose these plans at open enrollment because the monthly premium is lower. A client who picked a lower premium in the fall can owe the allowed amount for sessions in January, until the deductible is met. A high deductible health plan for therapy clients is easiest to manage when the cost conversation happens before the first visit. Our insurance deductible reset for therapists guide and open enrollment for practices guide cover the timing.

Whether a given plan pays for outpatient mental health visits before the deductible depends on the plan. HealthCare.gov notes that some plans pay for certain services before the deductible is met, so confirm it for each client.

High deductible health plan for therapy clients: 6 steps

1. Verify the deductible and the amount met so far. Use the patient benefit verification checklist.
2. Confirm how outpatient mental health visits are covered: deductible first, copay, or coinsurance.
3. Tell the client the expected cost before the first visit, in plain words.
4. Collect the patient portion at the visit or set up a payment plan. Our patient collection rate guide has ideas.
5. Ask whether the client pays with a health savings account card.
6. Re-verify when the plan year restarts, because the deductible restarts too.

Health savings accounts: how clients may pay

Per HealthCare.gov, a health savings account lets a client set aside money pre-tax for qualified medical expenses, including deductibles, copayments and coinsurance. A client can contribute only with an HSA-eligible plan, which HealthCare.gov says is sometimes called a high deductible plan. Whether a particular session qualifies is a question for the client’s plan administrator or tax professional, not for your front desk.

For the payment math on a deductible visit, see what a patient pays when they have a deductible, and for the three-way comparison see coinsurance vs copay vs deductible.

Cash pay, insurance and the high deductible gap

A client with a large unmet deductible may ask whether paying cash is simpler. Answer neutrally and describe both options. Our cash pay vs insurance for therapy practices guide compares them, and our Good Faith Estimate guide covers estimates for self-pay clients. Terms are in our patient financial responsibility terms.

Psychiatrist notes

Medication management visits are covered services too, so on many high deductible plans the client pays the allowed amount for each evaluation and management visit until the deductible is met. Confirm the rule for each visit type on the eligibility response. The same applies to a high deductible health plan for therapy clients who also see a prescriber.

High deductible health plan for therapy clients: the short version

• A high deductible health plan means the client pays more before the plan pays.
• Verify the deductible, the amount met and how visits are covered before the first session.
• Tell the client the expected cost in advance and collect it at the visit.
• Re-verify at the start of every plan year.

How MCM South helps

MCM South handles insurance verification, claims submission and denied claim follow-up for therapists and psychiatrists. A clear process for each high deductible health plan for therapy clients keeps balances predictable. See the Resources hub for more billing guides.

High deductible health plan FAQ

Where MCM South works

MCM South works only in mental and behavioral health. We serve psychotherapists and psychiatrists in solo and medium-size practices across ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. Need a payer contact? Use our insurance companies contact directory.