Navigating Behavioral Health Insurance
At River’s Bend, part of our job is helping you make sense of insurance so you can focus on getting better—not decoding benefits. We sat down with our co-owner, Bruce Goldberg, to talk about what coverage typically looks like for outpatient behavioral health, common hurdles, and how our team partners with insurers to keep your care moving.
“We’ve always been insurance-friendly.”
Bruce: “People have insurance—they should be able to use it. We verify benefits up front and explain what’s covered (and what isn’t) in plain language. Because benefits can change, we also encourage clients to know their plan. We’re on panel with almost all major insurances, so if there’s coverage, we can usually accept it.”
What that means for you: Before your first appointment, our intake team checks your benefits and walks you through the next steps. If anything looks unclear, we’ll help you ask the right questions.
The most common surprises: deductibles & co-pays
Bruce: “Over the last 10–12 years, many plans shifted to higher deductibles. Folks sometimes expect ‘insurance covers everything’ and then discover out-of-pocket costs. Employers also change plans year to year—clients aren’t always aware.”
How we help: We review expected costs before you begin, so there are no surprises—and we coordinate with you if plan details have changed.
How coverage works for IOP & PHP
Bruce: “Since the Mental Health Parity Act, commercial plans generally align mental health/substance use coverage with medical coverage. There aren’t hard visit caps the way there used to be—medical necessity guides approval. For outpatient, insurers are typically straightforward to work with.”
- IOP (Intensive Outpatient Program): Often doesn’t need prior authorization if medically necessary.
- PHP (Partial Hospitalization Program): Usually does require authorization. Our team handles that process and keeps you updated.
Bruce: “If an insurer approves, say, five or six days to start, it doesn’t mean care stops there—we submit updates to extend when it’s clinically appropriate.”
Billing myths & what insurers actually need
Bruce: “People worry things ‘won’t be covered’ or fear being fully honest about symptoms. In reality, insurers need a clear clinical picture. A diagnosis isn’t a label—it’s how insurance knows what they’re paying for.”
Tip: When you call us, share what you’re experiencing—depression, anxiety, trauma, coping skills, relapse risk—so we can match the right level of care and document medical necessity.
Getting approvals quickly
Bruce: “We have dedicated staff for authorizations—especially for PHP. Our goal is to secure approvals within 24 hours whenever possible and communicate decisions clearly to clients.”
Maximizing your benefits (without the headache)
Bruce: “We view insurers as partners, not adversaries. We’re in-network with almost all major plans and keep lines of communication open. If you want to call your plan directly, great—we’ll coordinate. The point is to get you the care you need.”
How the landscape has changed—for the better
Bruce: “When I started, it felt like ‘us vs. them.’ Over the last 10–15 years, insurers have leaned into outpatient mental health because it helps people earlier and often prevents higher-level care. We meet regularly with plans in Michigan, share feedback, and problem-solve together.”
Bottom line: Collaboration helps clients get timely answers and fewer roadblocks.
Do relationships actually speed up care?
Bruce: “Yes. Insurance can be complicated, so knowing who to call matters. It’s not frequent, but when hiccups happen, our contacts help us get to the right person quickly.”
A real-world win: Bruce recalls coordinating an out-of-state placement for a higher level of care through a single-case agreement—from first call to wheels-up in about four hours—because the team knew exactly how to advocate and whom to loop in.
Ready to get clarity on your coverage?
We’ll verify your insurance, complete a quick clinical assessment, and help you start at the right level of care.
This post is for general information only and doesn’t replace personalized benefits verification or clinical advice. Coverage varies by plan and medical necessity.
