I fully appreciate the benefits of having health insurance coverage and feeling entitled to make the most of your benefits, mental health benefits included. However, having been on both sides of the couch, I have a different understanding of insurance coverage and some of the unknown challenges. If your situation would only allow you to access mental health coverage through your insurance, you must do what is best for you. However, as a psychotherapist, I have decided not to participate with or be part of any insurance plan or network.
Here are a Few of My Reasons:
Mandatory Diagnosis of a Mental Illness for Coverage
A mental health disorder diagnosis has to be submitted by your psychotherapist for you to be eligible for insurance coverage or reimbursement. A diagnosis allows the insurance company to determine your eligibility for psychotherapy coverage as “medically necessary.” There are a myriad of reasons for which people seek therapy; many of which do not require and cannot be diagnosed. Simply put, if your psychotherapist does not assign you a diagnosis, your therapy sessions will not be covered/reimbursed. I am not comfortable assigning a diagnosis where none is necessary.
Lack of Confidentiality
When your medical insurance is used to cover your treatment, which includes full or partial payment, they have the right to collect information about your treatment. The insurance company has access to the type of treatment you receive and your diagnosis. The medical insurance company also has access to your records and the authority to dictate the number of sessions you are allowed. Your medical insurance company also has the right to audit your psychotherapy records, which gives them full access to details in the therapy room.
This information is then passed through a number of persons during the approval process, all with the aim to stop reimbursements as soon as possible. When you pay out of pocket, the information between you and I (or your therapist of choice) remains private.
Long Term Impact and Implications
Your diagnosis and mental health information is now part of your permanent medical records, accessible through a simple background search. Again, information shared in a safe environment with your therapist should remain between you and your therapist. Through a background check prospective landlords, employers, banks, life insurance companies, etc., could have access to your records.
Compromise Therapist/Patient Control of The Treatment
The medical insurance company, though not in the psychotherapy office, has all the control in determining the course, duration and the number of sessions allowed. Someone without any idea about your issues or the extent of your distress, arbitrarily determines what you should work on in your therapy, how long the treatment should take and if you are eligible in the first place. The insurance company expects your therapist to determine the number of sessions to “cure you” even before getting the full picture of who you are.
Working with the insurance company requires much more paperwork; from the therapist contract with the insurance company to the submission of notes or summaries for every session. The annoyance and time-consuming nature navigating through the red tape may delay payment, which may interrupt your treatment. This uncertainty adds an unnecessary burden to the therapeutic process and parties involved, you and your psychotherapist.
Above, are a few reasons I choose not to accept or participate with any insurance company. In summary, I strongly believe my clinical observations and treatment direction will be compromised by the involvement of the insurance company; my focus should be on you, and only you. After all, as an insurance provider I will be working for the insurance company and not necessarily for you. I am committed to providing the best possible service to you, without being conflicted by the demands of the insurance company.
This is meant to be information you can use to make the best decision for you and your situation. Again, do what is best in your given situation.