Using Insurance
For over 20 years in private practice, I have accepted most major insurances so individuals can receive therapy while using their health benefits as therapy can be a costly investment. It is an investment in yourself, your mental and emotional well-being, but insurance premiums are high and often deductibles are never met, so it makes sense to use insurance. During this time I have learned there are some definite reasons to not use insurance.
Insurance Requires a Diagnosis
In order to use insurance for therapy benefits, the insurance company requires me to provide a diagnosis. That means that once you enter therapy using your health insurance benefits, there is a documented record of a mental health diagnosis on file for you. This becomes a part of your lifelong medical record which could be available to your employer at some point.
For some that may be fine. For others, you would prefer that your mental health be kept more personal and not be documented in a file somewhere, or worse yet, documented where your employer may have access.
Not all people who seek therapy have a qualifiable diagnosis that the insurance company would reimburse. For example, if you are just going through a difficult season of life or need a neutral person to listen and help you process thoughts and feelings. Maybe you are having conflict with your family or co-workers and need to explore how to navigate through. These issues would likely not qualify for insurance reimbursement.
Only Certain Diagnoses Qualify
As mentioned above, not all people who seek therapy will have qualifiable diagnosis. The process to quality for a diagnosis requires the therapist to “prove” the care is a “medical necessity”. There are specific criteria that must be met for medical necessity and then follow up treatment plans must focus on the diagnosis.
If someone does not have a “medical necessity” qualifiable diagnosis, it can put the therapists in a difficult position, because we want to be able to help you. After all, we are in this profession because we genuinely want to help people be the best they can be. When someone wants to use their health insurance benefits for therapy, but they don't have a qualifying diagnosis, it puts the therapist in a position in which they may have to stretch the truth of your symptoms, for you to meet the criteria of a qualifiable diagnosis. So, now, not only will you have a mental health diagnosis on your record, but it may also not even be fully accurate.
Couples Counseling Isn't Covered By Insurance
When it comes to couples counseling, most insurances do not reimburse as many people are seeking counseling for issues around communication, conflict, or disconnect in their marriage and none of those things are qualifiable diagnoses. When accepting insurance for couple’s counseling it then becomes important that both parties have a medical diagnosis. All sessions are to focus on the diagnosis and documentation needs to reflect the treatment plan.
Sadly, insurance companies usually pay less for a couple session than an individual. This does not make sense, but it is the truth and so frustrating as it is double work for the therapist. To add to that insurance companies, make the claim process difficult, can take months to process the claim, or request “claw backs” years later. This means they can request a refund for the services already provided, giving the therapist no choice if they deem the service was not a “medical necessity” or any other reason they choose. They have also dictated the number or frequency of sessions regardless of the need or therapist’s recommendations.
Wrap Up
For now I will continue to accept a few major insurance companies, but have made the difficult decision to not accept insurance for couple’s counseling. This allows me to provide care in a way that is in the couple’s best interest, without adhering to the insurance company strict rules.
Therapist is an investment in your well-being and you're worth it!
