Behind the Couch: Understanding Why Therapists Opt Out of Insurance

 

Behind the Couch: 

Understanding Why Therapists Opt Out of Insurance

As a therapist, I've noticed an increase in the number of people who want/need to use their insurance benefits to receive therapy.  And, to be honest, when I first sought out a therapist for myself, I felt the exact same way.  

I understand.  Therapy can be a very costly investment.  But that's how you have to think about it - as an investment...in yourself and your mental and emotional well-being.

But working as a therapist, I've learned that there are some definite reasons that you may not want to use your inusrance benefits.

Let me take a few moments to explain.

Insurance Requires a Diagnosis

In order to use your insurance for therapy benefits, the insurance company requires that the providing therapist give a diagnosis.  That means that once you enter into therapy using your health insurance benefits, there is a documented record of a mental health diagnosis on file for you.  And that record may stay with you for a lifetime or could be shared with your employer.

For some of you, 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.  I think it is every person, every client's right, to keep their medical and mental health diagnoses or issues, private.  I personally don't feel that my health care insurance needs to know whether I have a diagnosis of depression, anxiety, or any other number of common mental health concerns.  And I would hate to think that that information could or would ever be used against me in some way.

And, not all people who seek therapy will have a qualifiable diagnosis.  You may just want someone to help your through a difficult season of life, or just need a neutral person to listen to you and help you process your thoughts and feelings, perhaps about your family, your co-workers, or others.  

Only Certain Diagnoses Qualify

As I mentioned above, not all people who seek therapy will have qualifiable diagnosis.  In order to qualify for insurance to cover your therapy sessions, the therapist must provide a qualifiable diagnosis that states that therapuetic care is a "medical necessity".  Much of what people come to therapy for, often does not qualify as medically necessary.  Again, it's frequently just to process through a season of life or difficult situation.

This puts therapists in a difficult position, because they 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, in order for you to meet the criteria of a qualifiable diagnosis.  So, now, not only will you have a mental health diagnosis on your record, it may not even be fully accurate.  

Couples Counseling Isn't Covered By Insurance

I work primarily with couples and generally speaking, most insurances do not cover couples counseling.  You MAY be able to get a partial reimbursement by submitting a Super Bill, but even that is not guaranteed.

Many people are seeking couples counseling, especially for issues around communication, conflict, or disconnect in their marriage  And, none of those things are qualifiable diagnoses.  So you see the problem, right?

Insurance Companies Significantly Underpay Mental Health Professionals

While we don't enter this profession for the money, we also still have to make a living, just like everyone else.  Not to mention that we spent extra years in school, internships, and gaining licensure hours, to be able to receive a professional license to provide you with quality mental health care, overseen by a governing body, to ensure that we are treating clients professional, ethically, and within our scope of practice.

Insurance companies often pay abouthalf of our full fee rate.  This means that in order to accept insurance, we will need to see more clients, in order to make the amount of money we need to make a living.  And in full transparency and all honesty, the more clients we see, the more likely we are to be burnt out or be on our way to burn out.  And when a therapist is burnt out, there's a possibility they are not as fully present during your session as they'd like to be or they're tired from already seeing quite a few clients before you that day.

And, on top of that, insurance companies make the claims process so difficult and can sometimes take forever to process a claim.  These factors also often deter therapists from being paneled with insurance companies.

Wrap Up

So to summarize, therapists most often choose not to accept insurance because it's in the client's best interest and because they want to be sure their clients are receiving the best care, while still maintaining their client's privacy.  Being private pay only, allows therapists the ability to work with their clients in the best way possible and meet them where they're at, instead of having to play into strict insurance company rules.  Therapists also want to be able to be fully present for you without having to figure out what diagnosis they MIGHT be able to use, to be paid for their services, and then hope they do get paid.

I know this isn't something that is frequently talked about, but I felt that it was important for you to know while you're making a decision on what therapist will be best for you.

Therapist is an investment in your well-being and you're worth it!

If you're considering therapy for yourself or for your marriage, please visit my website and schedule a free 15 minute consultation - www.brittaniedmillslmft.com.

I provide online couples and individual counseling throughout California, Tennessee, South Carolina, and Florida.

If you'd like to see any of my previous blog posts, please click here.

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Email - bdmills@brittaniedmillslmft.com

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