Insurance
Therapy that takes Wisconsin Medicaid (ForwardHealth)
Wisconsin Medicaid, including BadgerCare Plus.
ForwardHealth, BadgerCare Plus, and which one you have
ForwardHealth is the umbrella the state runs its health programmes under, and BadgerCare Plus is the one most people are enrolled in. If you have a card from the state and are not sure which programme it is, you are not alone, and member services can tell you in a minute.
One distinction genuinely changes who you call: some members are covered directly by the state, and others are enrolled in a managed care organisation, an HMO the state contracts with. If you are in an HMO, that organisation sets the network and answers benefit questions, not the state line.
Note
The limit worth asking about
Medicaid coverage commonly includes an annual ceiling on outpatient mental health, expressed in hours or in dollars, after which continued sessions need authorisation. Commercial plans usually do not work this way, so it catches people out part way through a year of steady work.
It is not a reason to avoid starting. It is a reason to ask at the beginning, so we can plan around it rather than discover it in October. Ask what the limit is, whether it has been used this year, and what the process is for continuing past it.
You are not getting a lesser version of therapy
Worth saying plainly, because people on Medicaid often expect to be a second-tier client. The work is the same work. EMDR, Brainspotting, walk and talk, the same pace, the same length of session.
What I’d ask them
- Am I fee-for-service, or enrolled in an HMO? If an HMO, which one?
- Is there an annual limit on outpatient mental health, and how much of it have I used?
- What happens when I reach it?
- Is telehealth covered the same as in-person?
Before you call me
How to check your own benefit
I can tell you I am in network. Only your plan can tell you what that means for your wallet, because the answer is set by your specific coverage rather than by the insurer as a whole.
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Look at the back of your card
The member services number is there. If there is a separate behavioral health or mental health line, use that one instead.
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Ask about your benefit
Ask whether your coverage is fee-for-service or through an HMO, and whether there is an annual limit on outpatient mental health. Medicaid plans often carry one; commercial plans usually do not.
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Write down what they tell you
Ask for a reference number for the call.
I’m licensed in Wisconsin only, so you need to be physically located in Wisconsin at the time of your session, whatever plan you carry.
Would rather not use insurance? Sessions are $125, and I keep a limited number of reduced-fee spots. More about fees
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