Considerations for Using
Your Health Insurance
Believe me, I get it. You pay for your plan and there would be significant challenges in trying to get help if you had to pay for it yourself. For some, coming in to work with me without insurance is never going to happen. It's just not possible. This is one reason why I still take a few select insurance plans.
Before using your benefits, I encourage you to investigate all options and arrive at an informed decision regarding your health care. You can always decide to use your benefits, but you can’t reverse many of the possible consequences after using them. Considering the frequency in which this question is asked of me combined with my own experience using my plan, I feel compelled to share some insights regarding the overall effects of using your health insurance for mental health treatment. Here are the main points for your consideration:
Know Your Plan
Be sure that you understand what your insurance will cover by either reviewing your summary of benefits or calling them. (Best to do both!). This includes knowing what your copay will be (which may be different than a doctor's office visit), what your deductible is, and what it does and does not cover. Your deductible is the sum total of medical costs you need to pay each year before your insurance coverage begins. If you have a family plan and you know you will meet the deductible, this will most likely not be a major factor. If you are on an individual plan with a high deductible you know you won't meet, then the financial impact of using your plan versus paying out of pocket is the same.
In order for insurance to pay for counseling, it must be viewed as a medical necessity by the insurance company. This means that the therapist must diagnose the client with a mental health disorder in order to be able to bill insurance for services and reduce your costs. While this might not seem like a big deal, please understand that this requirement is then considered a pre-existing condition on your record, which may affect other areas of your life as well as eligibility for life or disability insurance. This may be of no consequence to you if you already have a history of therapy or an actual medical condition, but it is worth noting if you do not.
Using an insurance plan for counseling also allows the insurance companies to dictate clinical decisions such as length of treatment, frequency/length of sessions, and again mandates a mental health diagnosis for reimbursement. I understand why this is considered important, since it helps to ensure a higher level of quality in theory, yet the end result is still a pre-existing condition. My data specific approach, has rarely had any major objections from insurance companies, therefore the risk is minimal. However, it is not unusual that I have had to do a clinical review to ensure services could continue, which most of the time was well warranted. The take away here is to make sure you call your insurance for specific details of your coverage.
While the basic limits of confidentiality will always be in place (plans to hurt yourself or someone else must be reported as well as legal requests) using insurance makes it more difficult to ensure confidentiality since your information will go through the hands of multiple insurance employees.
These are facts that I wished I had known when making past health decisions. I believe them to be the key aspects of making an informed decision, but I encourage you to research this further for yourself by doing a google search for "pros and cons of using insurance for therapy". I also highly recommend the following guideline which outlines all the ways insurance can be used to pay for therapy so you can learn how to maximize your plan and reduce your risks.
By paying out-of-pocket, we can bypass these risks and avoid providing a diagnosis, especially if one is truly not needed. There will be no diagnosis on your permanent health record, and no one will ever know you’re in therapy unless you tell them. Regardless of the option you choose, I take the issue of confidentiality very seriously and will make every effort to ensure your records remain confidential.