Should I Use My Insurance for Therapy?


Health insurance lowers your out of pocket costs, right? Or does it? Ever thought the disadvantages of using insurance? Are there health and wellness services or products you pay for that are not covered by insurance?

Let me ask you, do you spend extra gas money driving across town to buy organic groceries; belong to a health or fitness club, buy monthly supplements and vitamins, pay for karate, dance or art classes for your kids?

Do You Consider Counseling a Priority?

Ask yourself, what assumptions and beliefs do you have about therapy. Do you believe it is for "crazy" or "really depressed" people or can most people benefit from an "emotional check-up?" How much do you think therapy should cost per session? A $20 co-pay, $100, $150? Will you pay more for a therapist with specialized training and extensive experience? What about location and convenience of scheduling? Do you believe you get what you pay for?

5 Facts About Using Insurance

1. Medical Necessity Rules Everything

Insurance companies require your counselor to give you a mental health diagnosis. Sometimes you might just need someone to talk to and help you clarify what you want and give you some suggestions for positive, healthy changes in your life. Or you may be going through a divorce and need some guidance. Managed care companies will not provide reimbursement unless all services directly relate to treatment of a mental health diagnosis.

2. Insurance Companies Decide Who Your Provider Is Along With Frequency of Services

Insurance companies decide what providers you can see and either charge you a higher co-pay or do not reimburse for services with an out of network provider. They also require therapists to accept a lower rate of payment for being part of their network.

3. Confidentiality Is Not Guaranteed

A minimum of 8 people will have access to your mental health record, including diagnosis and details of your treatment. If you have insurance through your employer, they may ask the insurance company for your records regarding treatment.

4. Higher Life Insurance Premiums

If you use your medical insurance, your mental health diagnosis becomes part of your permanent medical record. If you apply for life insurance, the underwriter will request medical records from your provider and/or verify if you have a record of mental health issues. Major Depressive Disorder is a sample of a diagnosis that has a higher mortality rate, making you a higher risk for insurance companies to insure.

5. Denial of Promotions or Civil Service Employment

Sometimes, a history of mental health issues can interfere with employment as a police officer, government official or civil service agent. It can also prevent you from receiving promotions and advancing in your career.

Let's take a look at the following examples:

Example A: You choose to use your insurance for therapy services for your 8 year old son that doesn't like to talk about his feelings. A provider has been chosen, however she has minimal availability of after school appointments. Your son has academic issues, yet needs to be taken out of class for therapy appointments across town. Your son spends 45 minutes in the car, in addition to time spent at his appointment, a minimum of twice a month.

It is difficult to reach his therapist between sessions to talk about therapy progress as she is overbooked with other clients. As such it is more difficult to establish rapport and understand her therapeutic approach. Therapy progress takes longer than anticipated, involving 6 months of weekly sessions:

$40 x 24= $960

Example B: You choose a provider specializing in ADHD, offering after school and weekend appointments. She is responsive to emails and phone calls, offers longer session times as needed and provides opportunities for you to ask questions. Her office is 10 minutes from your home and she recommends homework assignments to decrease impulsivity, improve attention and academic success. Therapy is effective, lasting approximately 8 weeks.

$125 x 8= $1000

Until next time,

Sara Minges, LPC


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