A Few Thoughts on Seasonal Affective Disorder
written by, Kate Oliver, MSW, LCSW-C
This is the time of year when, like many clinicians, I see a spike in the number of people calling for first time appointments. One of the reasons for this is Seasonal Affective Disorder (SAD). SAD can impact both adults and children.
At it’s core, SAD is a kind of depression that occurs at a certain time of year. If you have ever heard people talk about the “winter blues,” they are typically referring to SAD. Two issues I see which keep people from seeking treatment for SAD is that they worry about being put on medication, and that they have normalized feeling blue at this time of year. If this is you, please allow me to educate you about some of your easy, quick, medication-free options that you might want to try.
1. In the United States, there is an epidemic of people who have lower than optimal Vitamin D levels. Vitamin D is that essential nutrient we get from the sun that, among other benefits, helps us to regulate our moods. As people spend more time indoors, and get better about using sunblock and covering their skin in the sun, we also end up getting less Vitamin D in our system which impacts our mood. We are more prone to this in the winter months. Your Vitamin D level is a quick and easy thing to test. If you have a regular doctor, you can contact them and ask them to test you for your Vitamin D levels. If you do not have a doctor, there are in-home kits you can order off the internet.
2. Talk to your physician about a sun lamp. These are special lamps that produce light which mimics the sun and, for people impacted by a change in the seasons, they also help to even out your moods. You can even purchase them inexpensively online.

English: A 30 kHz bright light therapy lamp (Innosol Rondo) used to treat seasonal affective disorder. Provides 10,000 lux at a distance of 25 cm. Suomi: 30 kilohertsin kirkasvalolamppu (Innosol Rondo) kaamosmasennuksen hoitoon. Kirkkaus 25 senttimetrin päässä 10 000 luksia. (Photo credit: Wikipedia)
3. Take fish oil. Iceland, a nation where people experience shorter days and longer periods of darkness has one of the lowest levels of depression anywhere, why? The eat fish like it’s candy around there! Okay, maybe not like candy, but they do eat a lot of fish and fish oil specifically has been linked to reducing depression. Obviously, you want to check with your doctor before starting this, especially if you have any seafood allergies or if you have any blood related issues especially as fish oil can change the clotting of your blood.
4. Try therapy. You might not have SAD. Just because you experience depression around this time of year it does not necessarily mean you have SAD. I see many people who, around the anniversary of a specific trauma, experience some symptoms consistent with depression. If you have a loved one that passed away this time of year, you might be missing them more. Even if they didn’t pass away this time of year, if you have specific memories linked to this time of year (this happens a lot around holidays), you might be sad thinking about them. Death is not the only trigger, perhaps you experienced the loss of a job, a relationship, or something else around this time of year. If you have not resolved those losses to the point of acceptance, you may just be getting triggered to remember that particular feeling and your brain is giving you a chance to resolve the issue now. I find that seeing a good therapist is essential in this process and that some people who have told me they have SAD have actually, via therapy, addressed and resolved old issues that pop up around this time of year making it so that they did not experience SAD the following year.
For more about Seasonal Affective Disorder from the experts, please check out the link below from Everyday Health.
Related articles
- Seasonal Affective Disorder Awareness Month (everydayhealth.com)
- How to Know When You or Your Child Need a Therapist (help4yourfamily.com)
- Finding the Right Therapist for You and Your Family (help4yourfamily.com)
Suicide Prevention: Determining if Someone is Suicidal
Written by, Kate Oliver, MSW, LCSW-C
Over the years, I have talked to many, many parents, partners, and spouses about what to do if you think someone you love might be suicidal. There are really two parts to figuring out about suicide, 1. determining whether someone is indeed suicidal, and 2. if the person is suicidal, figuring out the level of risk and making sure they are safe. I am going to tackle one section a week so stay tuned for next weeks post. I want to state at the beginning of this post that, of course, my advice here is general and should not be substituted for individualized mental health advice. If you absolutely know someone is suicidal, please take them to the nearest emergency room or contact your local mental health hotline. And, if you are reading this post because you have someone you are concerned about, even if they are not suicidal, please do your best to encourage and support them in seeking therapy as soon as possible. There are mental health services available to many in the United States even if you are under-insured or are not able to afford counseling.
Determining whether someone is suicidal
There are times when you absolutely know someone is suicidal, either you found a note, they told you they were, you find them in the process of attempting, etc. But other times it can be more difficult. Sometimes parents tell me they think their adolescent is saying they want to die in order to get attention. If this is happening, please stop for a moment to think how desperate you have to feel about getting attention in order to say this. I want to make sure that you know that, even with young children, any indication that someone is suicidal needs to be taken seriously. Even if you think they are trying to get attention, don’t you think it would be a good idea to give them some if things have gotten this extreme? I’ve actually come to know of quite a few people via the work that I do who have tried to “get attention” by attempting suicide in the hopes that someone would notice them. I wonder how many suicides are just that, someone thinking they are doing something to get attention but they actually end up dying. Pay attention! Here is what I recommend to all parents who tell me that their child is saying they are going to kill themselves for attention. Tell them you need to take any statement like that seriously and ask if they are serious. If they say that they are, take them to the hospital. Here’s the thing, I know you might say to yourself, “I don’t want to waste the time of the hospital personnel” or, “This kid is trying to waste my time.” Take them to the hospital. Tell them you love them and that you have to take this threat seriously. Sit with them for the hours it takes to be seen. If they are not suicidal, they will be so bored and so over it that by the time you have finished with it, they will never want to have to do that again. You will have nipped a nasty reaction in the bud. The alternative when you take them to the hospital is finding out that they were, in fact, serious and you took them right where they needed to be anyway.
Here’s the thing about the hospital. They are busy. They don’t want to take your child, your friend, spouse, etc. unless they think they need to. Just like they are not looking to keep people for any extra time after surgery, they are not looking to take in people who do not actually need to be there, so please do not worry, the person you take will not be admitted unless they need to be, in which case, you did the right thing.
Warning signs
Other times, you may have someone who you care about who you fear may be suicidal and not telling. Maybe they have had a series of unfortunate circumstances or are having a mental health issue, like a depressive episode. Here are some warning signs that a person is more likely to consider suicide as an option:
- They have had recent loss such as a death in the family, ending of a significant relationship or loss of a job.
- They have a history of depression. Depression is characterized in adolescents differently than it is in adults. Adults tend to have a loss of interest in their usual activities, difficulty attending to tasks, a sense of hopelessness. In children and adolescents, depression more often manifests as irritability and anger.
- They have friends or family members who have committed suicide.
- They have mentioned, even just in passing, that they should just kill themselves, or that they wish they could die. Sometimes they may talk about everyone being better off without them.
- They suddenly begin giving away important items you would not expect them to give away and seem to be suddenly peaceful after a period of difficulty.
- They begin to isolate themselves from friends and family members.
- They have increased alcohol or drug use and/or impulsive or reckless behaviors.
- They have previously attempted suicide in the past.
If you notice any of these symptoms, please take these next steps to ensure that your loved one is safe. Better safe than sorry, as they say. It is especially true in this case.
Stay tuned, next week I will write about what to do to support someone if you fear they are suicidal. In the meantime, here are a few resources.
National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
American Foundation for Suicide Prevention
How to Know When You or Your Child Need a Therapist (help4yourfamily.com)
Related articles
- Suicide Prevention: Determining if Someone is Suicidal (help4yourfamily.com)
Who’s Who in the World of Mental Health
Written by, Kate Oliver, MSW, LCSW-C
In the field of mental health, you will come across many titles for professionals. It can be confusing to understand what the differences are. Here is a quick primer to walk you through the different types of helping professionals in the mental health field.
Social Workers- We typically have a Master’s Degree followed by a few years of supervision with a mandatory test to obtain a license. Each state has different standards for Social Workers and it is a good idea to check what a license means in your state. In my state, Maryland, in order to have my clinical license I needed to complete my Master’s in Social Work, then have a minimum of two years and 1500 hours of supervised work time. After that I needed to pass my licensure exam. In my state there are also Social Workers that have other certifications that mean they do not have as much training or experience, and or that they declined to take or did not pass the licensing exam meaning they still must be supervised by someone trained to supervise Social Workers. The lens Clinical social workers use when working with clients is typically to look at a person in the context of their environment to see what environmental stressors a client has and to work with a client to see how we can help them better manage within the system they live in. Social Workers do not prescribe medication
Psychologists have a doctoral degree. They also are required to take an exam following their degree and need to be supervised during and after school for a period of time before practicing without being supervised. Psychologists tend to look at patients (Social Workers call them clients, psychologists call them patients) through more of a medical model i.e.- in what ways is this person not functioning? What are the symptoms…let’s treat the symptoms. Psychologists do not prescribe medication.
Professional Counselors have varying ways to describe themselves, Licensed Family Counselors, or Licensed Marriage and Family Counselors. Like Social Workers, Professional Counselors have Master’s Degrees with supervision and testing following their Graduate Degrees, however their Master’s is in Counseling rather than Social Work and they are more likely to be trained in methods akin to a Psychologist, and/or have specific training for their license such as specialization in Marriage and Family work rather than working with individuals. They do not prescribe medication.
Pastoral Counselors have a Master’s or Doctoral degree in Pastoral Counseling. They come to counseling with a spiritual perspective often related to a specific religion and will bring in religious and mental health elements into their work with a client. They do not prescribe medication.
Psychiatrists are trained medical doctors. Psychiatrists have been through a full medical training with all the tests involved with becoming a doctor but, just as a Pediatrician specializes in working with children, Psychiatrists specialized in mental health. They most definitely tend to see patients through the medical model and do prescribe medication. Psychiatrists often meet with patients for about 30 minutes and do medication monitoring. I would highly recommend that anyone seeing a Psychiatrist also see a Psychologist or Social Worker as it is unlikely you will be getting any talk therapy with a Psychiatrist.
Mental health providers may be found in many different places, schools, hospitals, and in private practice. They may provide individual, group, couples or family therapy, or a combienation of all of those. No one group of practitioners has been found to be more successful in treatment than any other group. However, there is one factor that increases the effectiveness of treatment across mental health provider types. It will probably come as no big surprise that regardless of training background or methodology, the strength of the relationship between a client/patient and the provider is the number one predictor for success in treatment. So, if you see someone a few times, and the chemistry is just not there, it is probably time to switch to another provider.
Related articles:
- Finding the right counselor/therapist for you and your family (help4yourfamily.com)
- How to know when you or your child need a therapist (help4yourfamily.com)
When your inner critic hurts your relationship with your children
Written by Kate Oliver, LCSW-C
We all have an inner critic. Some of us have several. You know, that voice in your head that just feels like it is part of you? It’s the one that tells you that you did it wrong again, you are not working hard enough to fix your child’s problem, and reminds you of all the times you tried and failed to get items knocked off your “to do” list. If you are not fully familiar with your inner critic, the next time you are upset about something, take a moment to listen to your thought process. What are the thoughts floating through your head at that moment? Our inner critic can be harsh…and sneaky. We don’t even know it’s there, it feels so much a part of us.
I’ve heard our inner critic (or critics) referred to as “the committee.”
I love this because it is so true. Think about the act of going to the grocery store and passing through the cookie aisle. The committee gets activated! You hear one part of your committee saying, “Get the cookies you like, you deserve it!” Another part of your committee chimes in, “Yeah, your butt loves those cookies so much it will hold onto them all the way through summer.” Then the internal negotiator pipes up, “Maybe there is a new, healthy cookie out that you could try. Or, if you get the individual packs, you won’t eat the whole thing in two days and you can enjoy your cookies over the next few days, a little at a time.” Of course then the critic chimes in, “Fat chance…get it? Fat chance? Haha.” And so on. Even after making a temporary decision to leave the aisle, or put the cookies into the cart, your mind wanders back as you continue through the store, either feeling like you should take the cookies out of the cart, or wondering if you will pass by other cookies and if you will be able to pass them over too. Is it just me? I don’t think so, maybe for you it’s not cookies, maybe it’s picking the right birthday card for a friend, or what job to take, the email you are sending to a friend, etc.
When the committee gets involved, we can all empathize with the wish someone stated to me once when he said he wanted to put them on a bus and send them away for the weekend. Since that is not possible, what is the alternative? I have one that may surprise you. Think about loving them. That’s right, envelop each part of your committee with love and thank it for working so hard on your behalf. Right now I imagine there are quite a few people reading this who will argue that there is a part of them that is just plain wrong, that it is a part they would like to eliminate completely and that the focus should be on eliminating the “bad” parts. If you are saying that, here is my question to you…how is that working for you? I’m guessing that has not been so successful or you would not still be reading this post. I might suggest that telling them to go away hasn’t been working so well so far.
If you want to try something new, take a moment to reflect on what it is each member of your committee is trying to say to you. Try to listen to one at a time. Are they trying to convey important information about your health, safety, or emotional well-being? Is your committee chiming in about ways to keep yourself or your family safe? Is it reminding you of something you need to know right now? I promise you that even the most seemingly destructive parts of you are trying to help you in some way. When you figure out the message, imagine yourself giving that part of you a hug and thanking it for it’s input, like you would a friend that just told you something that was really hard to say. Make sure it knows you got the message and that you will take it into consideration. Often times these parts of us, our committee, can be like any other team meeting where, if people feel like their important message is not being heard they just repeat it over and over again, saying it louder and louder, until people finally take notice. Your committee may be doing this now.
Remember, listening to your committee does not mean that you will do exactly what they say, but, just like your children, if you take time to really listen to them, and they feel heard, they are more likely to listen when you tell them no, feel good when you agree, and feel less and less like they need to yell to be heard.
If it is confusing when I say to listen to your committee then listen to yourself, since your committee is part of you, that is understandable. What I mean is, your committee members are all aspects of who you are. At your core is you. The you who knows what you really need, the you who is connected to all the love you feel for yourself and others, the you that does not need to judge anyone else, and is the same you that is connected to a higher, spiritual purpose. Some people call it their higher self. We all have this, it is the part that tells us we can do this, forgives us our imperfections, and that finds creative ways to solve any issues. Take a few moments each day to connect with your committee, then to connect with your core, or higher self. If you worry about fitting this into your daily routine, remember, thinking is free and can be done anywhere. Even people with young children can take a few minutes a day to sit when the kids are in bed or are eerily quiet in the next room to check in with their inner dialogue. The process of getting to know yourself and find peace within does not happen in one day, rather, it happens in increments over time. It takes a lifetime, which is okay, because you have that long to do it.
A word of caution, your committee may try to tell you that doing this is too difficult and to stop or you won’t like what happens next! Should you hear that warning from your committee, I would urge you to find a therapist to help you navigate the murky waters of your inner workings. Over time you will find that the process of getting to know yourself can be like finding a long, lost friend that you have been missing desperately for a long time.
Doing this exercise is especially important for parents because, I hate to tell you, our inner dialogue shows to our children whether we like it or not and becomes their inner dialogue. The best thing we can do for them is to clean up our inner space and be infinitely loving to ourselves so that our children may follow our example.
There are guides for this type of work as well. Self-Therapy: A Step-By-Step Guide to Creating Wholeness and Healing Your Inner Child Using IFS, A New, Cutting-Edge Psychotherapy, 2nd Edition by Jay Earley (Jan 27, 2012) is one such book. It is available on Amazon and if you click on the Amazon widget link at the top right of this screen you can find out more about it. Please read my disclaimer page.
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Talking with Robert Holden
Written by, Kate Oliver, LCSW-C
On Thursday of this week I decided to try calling into one of my favorite radio shows, Robert Holden’s Shift Happens. It comes on at 1pm EST. Every Thursday is the day I stay home from the office and try to get enough done around my house so that my family and I can have a weekend free from running errands and picking up the house. I always listen to Hay House Radio using my phone app as I clean. If you don’t know about Hay House Radio, it is a station dedicated completely to positive radio programming. I love listening to Dr. Holden because he is always gentle and kind to everyone he speaks to and has a wonderful way of helping people to look at things in a different way.
I’ve had an unusual amount of anxiety lately, really since I started this blog. While I have taught other mental health professionals and parents in educational seminars, I’ve never publicly shared my writing until now and I have been feeling, well…vulnerable. So, I called into the show, anticipating a busy signal. How surprised was I when the phone rang and someone asked me what my reason was for calling before putting me back on hold? Umm, pretty surprised. I am so grateful for the time I had on hold so that I could gather my thoughts. Then, just after the commercial break, I heard Dr. Holden announcing…me! What a wonderful, effortless surprise :).
I know most people hate public speaking. I actually love it. I know I have good, worthwhile information to share and I love being with people as we all gain knowledge together. When I am in front of an audience, I can see people responding and adjust accordingly. But with this blogging thing, it’s like I’m putting my baby out into the world and it’s difficult for me to see how people are responding. When speaking in front of an in-person audience, I also know who is there (no one I know personally) and it is easy for me, in a professional setting, to shrug off criticism. I know what I am saying some people will respond to and some will not. Remember, I work with children with difficulties with attachment. I probably hear a few times a week that I am wearing the wrong clothes, have a weird look on my face, don’t have the right games in my office, and that I am just plain wrong. I usually find it pretty amusing since I know that criticism is more reflective of where my client is and if we stick with it, we will get to the other side to figure out where the defensiveness is coming from.
While speaking to Dr. Holden, I realized it was not so much the people I don’t know reading my blog, but more the people I do know. It’s funny the things we worry about. Mostly I was worried about people I know personally changing their opinions of me, or my blog causing conflict with people I love. Everyone else, if you like it, wonderful! If you don’t, I sincerely wish you luck in finding a site that better suits your needs.
The most surprising part of the call for me was toward the end when Dr. Holden suggested that if I am worried about critique from people I know and am most connected to, the concern I focused on in my call (no perfectionist tendencies here), that I must begin to be the most loving, least critical person I can be. I had a little inner battle about that one. “No, wait!” my insides wanted to cry, “I’m not critical of others! In fact, I am one of the least critical people I know! I pride myself on being non-judgemental!” But then, after the call it clicked. I am loving and non-judgemental to many, many people with one major exception. You know the exception, right? Yup, it’s me. I have a tendency to save my major criticisms for me. Don’t we all? I mean, when we are yelling at our children, isn’t part of it that we are berating ourselves for our perceived lack? Our inability to get them to eat what we want them to eat, the anger over the clutter or mess in our homes taking over that we can’t seem to keep under control, or feeling like we do not know how to address an undesireable behavior? It is on the days when we are harshest to ourselves that we are the most harsh with our children. I realized from that call, (thank you Dr. Holden) that I need to be less critical to everyone.
Let this be a reminder to us that we all, even the experts, need reminders to be gentle, kind and loving to ourselves. Thank you to all of the people who have contacted me since hearing me on the call. It has warmed my heart and I welcome building continuing relationships with you. I hope that I can also take part in helping to you be kinder and gentler to yourselves as you continue your own journey as parents, no matter the age of your children.
You can listen to the show here: http://www.hayhouseradio.com/listenagain.php?latest=true&archive_link_type=link_mp3&archive_id=9401&show_id=180&episode_id=8697
This archive is available for only the next few days for free then it will go into the permanent archives and will cost money.
If I remember correctly, my call was the second after the break at the half way mark. You can buy Dr. Holden’s book Shift Happens, on Amazon by clicking on the Amazon widget on the top right of this page. I do not receive any financial compensation for this post or for any referrals to Hay House, or Dr. Holden however I do receive a nominal fee for purchases from Amazon if you click on the link on this page. I only recommend products I believe in strongly.
Ten Free Ways for Parents to Break Free of a Bad Mood (I’ll bet there are a few you’ve never thought of)
Picture yourself, it’s Sunday around 3:00 pm. You have already watched the children slowly dismantle any progress you made in getting the house into order over the week while they were in school. They have gone through the playdates, video games, television and 1/2 the board games- as evidenced by the living room floor. As you think about whether you are up for making dinner and wondering if you even have anything to make, you start to get grumpy. Okay, you were already grumpy. Maybe you have already yelled at them a few times and now, in addition to feeling overwhelmed about the mess in your home, you are also feeling bad about the words you have said- not that you are going to stop saying them mind you, because you are stuck in a loop of grumpy, nasty behavior…the same kind you get angry with your kids for having. Below are a few techniques to help break free from the grumpy nasties and I’m quite sure there are a few you have not tried yet. Why not print out the full list at the bottom of the post and stick it on your fridge to try out when the grumpies strike again?
1. Put the kids in the tub or shower or take a bath or shower yourself. Something about being in the water helps to set the reset button for kids and sometimes adults. If you are taking a bath or shower, visualize all the angry, grumpy feelings getting washed off of you and watch them go down the drain.
2. Set up a behavioral chart for yourself (if you get through something without yelling, you get a point and x number of points gets you something like a night out, a new cd you’ve had your eye on, etc. I cover this one in my post “Ditch Your Behavior Charts!”).
3. Tap on the inside of your pinky finger and say three times “I forgive myself, I did the best I could do.” Then, continue tapping and repeat three times “I forgive myself, I’m doing the best I can.” Don’t ask how it works, it’s an accupressure technique, just try it! You know a big part of what you are doing has to do with the way you are talking to yourself about what is happening right now. Think about ways you can forgive yourself- this is one of them.
4. Imagine you are speaking to someone who loves you, your best friend who always knows what to say, your grandmother, whoever, and pretend they are with you right now guiding you.
5. Learn EFT. EFT (Emotional Freedom Technique) is a quick, easy tapping technique that can help in all kinds of different areas of your life. It addresses anxiety, depression, traumatic memories and much more. Here is a link to someone teaching EFT. I would recommend just doing the shortcut he teaches in the first 6 minutes. It’s all I ever really teach and it seems to be enough. http://www.youtube.com/watch?v=NPZ-xmj6KTI&feature=related. If you really want to learn more, check out this site: http://eftuniverse.com/index.php?option=com_content&view=article&id=18&Itemid=21
6. Do a quick 5 minute spurt of exercise even though it is the last thing you feel like doing right now. Partly this is just going to break the pattern by doing something different from what you were originally going to do next. Add to that a quick, natural endorphin rush, and a feeling like you just took care of your body for a moment and it can really do the trick. A great exercise that we do sometimes in our home that really gets us moving and laughing is playing “Just Dance” on the Wii. We crack up as we watch each other try to get the moves right. Just make sure no one gets hit with the remote. Remind yourself that you don’t have to be at the gym and doing a full workout to get a little benefit from exercise. See how long it takes you to go up and down the stairs of your home or apartment building 10 times, jog in place, race the kids a few times in the yard.
7. Cry. You read that right. Think of the energy we spend holding back tears when really tears can be quite healing and good. Even better than crying is crying in a hot shower. That really gives your body a release. Your tears actually carry stress hormones, that are otherwise trapped in your body, out of your body. So, when I say it’s a release, I mean it, you are letting go of stress hormones when you cry. Also, people worry about crying in front of children. Unless this is a recurring issue- in which case I think you need to read my post on finding a therapist, crying in front of your kids a few times a year is okay and actually can teach them about allowing themselves to show feelings and get comfort.
8. Change locations. When the kids were little I called them, “I need a witness days.” I didn’t need a witness for them. I needed a witness for me. I needed to go out of the house so that I would be more mindful of how I was acting with my children. Also, just getting out and going to the park gets you away from some of the compounding factors that may be contributing to your mood.
9. Accept help. Remember how you did something wonderful for your friend or neighbor and they were so thankful and told you if you ever needed anything to call? Call. Ask for help. Accept imperfect help from your spouse, partner or friend while you go out to take a walk or clean up so you can feel sane again. Sure, they may not do things the way you want them to, but are you doing things the way you want to right now? Right. Ask for and accept the help.
10. Picture yourself tomorrow, thinking back on today. What do you want to say you did today when you were feeling this way? Do you want to say, “yesterday I was in a foul mood and I couldn’t pull myself out of it?” or do you want to say, “Yesterday I was in a foul mood, then I remembered this list of things to do to get me out of it. I looked on there and found something and I’m pretty proud of myself because I gathered the children and pulled myself together and we all went for a walk. The rest of the day went pretty good.” Once you have pictured what you want to say. Break it down into three smaller steps, what you need to do to get to feeling that way.
Good luck! Let me know what works for you, or, even better, add to the list…
Related articles
- Does my child need medication? (help4yourfamily.com)
getting insurance to finance specialized therapy
No matter how you feel about the whole health insurance debate in the United States, I think most of us can agree that dealing with insurance companies can be confusing and frustrating. It can almost seem like the insurance companies have their own special language and code words. If you have a child in need of specialized therapy, or you are in need of therapy yourself, going through your insurance can seem really daunting and to add to the difficulty, many specialists no longer deal with insurance. My hope is that this post will help you navigate the way US insurance companies work so that you can get services paid for (even if they are out-of-network).
Do not let your insurance’s first response, where they say they are not funding an out of network provider, or they say they will but will only pay 20%, throw you off. You still have options, they just aren’t going to tell you what they are. Let’s start with a quick primer on insurance “lingo” you need to know:
in-network providers– are providers covered by your insurance company. If you are going to an in-network provider your insurance company has an agreement with your provider so that they are likely to pay most of the bill except for your regular co-pay.
out-of-network providers– are providers your insurance company does not have an agreement with. If you are calling your insurance company and they say the provider you are calling about is out-of-network, you will want to ask if you have out-of-network benefits on your plan. If they say no- do not panic- you have options!
usual customary rate (UCR)- is the rate your insurance customarily agrees to pay for a given service. When your insurance says they will pay 70% of the UCR that means they will pay 70% of what they normally agree to for that service- which is often different from what the specialist charges. If your insurance says they cover a percentage of the UCR, ask them what the UCR is for the service you are getting. If they say $80 and they cover 70% of the UCR, that means they will reimburse you or the therapist $56 and you would be responsible for the remainder of the UCR if you are seeing an in-network provider, or the remainder of the provider’s fee for out of network providers.
Now that you know these terms. give your insurance a call and see what they have to say about the provider you want to see. Remember to also ask if you have a deductible and how much of your deductible has been covered. Other insurances have a rate that changes, for example, they pay 20% for sessions 1-5, 40% for session 6-30 and 70% for sessions 31 and above. Don’t worry, I’ll summarize at the end so you can get all the questions together.
So, what do you do if your insurance company tells you your chosen specialist is not covered?
Gather the information that makes your provider special. Do they have special skills and training to help your child that other providers do not have? My clients that call would tell their insurance I have specialized training in trauma, attachment and adoption- if they are bringing their children for one or all of those reasons- pick only the issues that pertain to you and your child. Ask your insurance if they have anyone in-network that provides that same level of expertise. Your insurance is required to find someone with comparable skills within a reasonable distance of your home who has the specialized skills you require. If they do not, they are required to offer to pay their UCR to your specialist. If you have a willing specialist, with just a short conversation with your insurance, they can negotiate a rate for services. I have done this several times now.
To summarize, the questions for your insurance are:
1. Is (name of the provider) in-network for my plan?
2. Do I need authorization?- asking the question starts the process if you need it.
3. If my provider is out-of-network, do you have an in-network provider with the same skills and availability within reasonable distance from my house?
4. If you do not have anyone in-network, could you offer the provider a single case agreement?
5. What is my deductible?
6. What is the reimbursement for this service?
7. If they mention UCR, what is the UCR?
Remember, if they say they have an in-network provider with the same skills as your specialist, make sure to follow up and call that specialist to make sure they are taking clients because if they are not, you can call the insurance back to report and they need to find someone else or offer a single case agreement.
In case you understand better with a flow chart, I have included one of those below as well. If you have further questions or would like clarification, please ask in a comment. This stuff is confusing and someone else probably has the same question!
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