COUNSELING - EDUCATION - SUPERVISION

There are pros and cons to using your health insurance benefits to pay for mental health care. Although you are entitled to connect with a counselor that accepts your medical benefits, you may ultimately decide that the flexibility and privacy afforded by paying directly is worth any extra cost.  It would be a mistake to be dissuaded from seeking treatment because of the issues surrounding health insurance coverage for mental health.

 

Pros:

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• If you have coverage to see the provider you choose, it will

probably be cost effective to use your health insurance to

pay for services.

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• Whether you are self-employed or work for an employer,

you effectively pay a lot of money to have health insurance

and it may make sense to get the most out of your benefit

package by using insurance for therapy.

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• Providers on health insurance panels are generally well-established in the community and may have more experience than providers who do not accept health insurance.

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• Jane Simmons is an in network provider for Cigna, and United Heatlh (Optum)

 

Cons:

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• There are many circumstances in which you might want to keep the fact that you are in treatment, as well as any information about that treatment, completely private between you and your therapist.

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• In order to qualify for benefits you must surrender a level of confidentiality to the insurance company that would otherwise remain between you and your therapist.

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• Insurance company employees may ask for personal information to determine whether or not they think treatment is warranted.  These employees decide if you are eligible for treatment, rather than leaving that decision up you and your clinician.

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• In order for insurance to reimburse your treatment you will receive a mental health diagnosis that goes in your permanent medical record. This diagnosis constitutes a “pre-existing condition” that may be a disqualification from benefits in the future or may otherwise interfere with your coverage if you change plans and sometimes warrant longer times, typically with no increase in rates.

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• Some insurance companies offer different coverage depending on the severity of the diagnosis.  This means that a more severe diagnosis authorizes the client to receive more sessions with a lower copay and higher rate of reimbursement for the clinician than a less severe diagnosis.

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• Insurance rarely pays for marital or relationship therapy.  Instead, one partner will be identified as the “identified patient” and will receive a mental health diagnosis.  The insurance company will then authorize conjoint treatment for that person and his/her partner.

 

Additional Information

If you do not want to use your health insurance and are limited in what you can afford, Peaceful Mind Therapy offers lower fee services on a sliding fee scale for consideration of those in special need.  You can also consider scheduling sessions less frequently or shortened sessions.  Many types of therapy, mine included, do not always necessitate weekly visits.  There are a variety of ways to think about the purpose and process of therapy.  Insurance companies see therapy as treatment for a mental illness or

 

condition and they treat the insured as patients who will either qualify or not qualify for the treatment.  This is not an invalid way to think about mental health care, but it is not the only way.  People are usually looking for relief from symptoms of some kind when they seek help.  Many come to find that therapy becomes a tool for enhanced personal growth, responsibility, and relationship satisfaction.  The medical model of diagnosis and treatment is no longer particularly relevant at that point.