While it’s great to have insurance help defray the cost of counseling, what you don’t know about mental health insurance could really cost you, in more ways than one! So here are 3 things you need to know before using your insurance for counseling.
Insurance will only cover counseling when you are diagnosed with a mental health disorder.
Insurance companies, as one of the primary driver of our current “sick care” system will only cover what is “medically necessary” or a “diagnosable mental health issue”. (Many insurance companies, for example, do not cover couples counseling or marriage counseling because it’s not considered medically necessary). This means that if you choose to use insurance, your counselor must label you with a diagnosis that the insurance company finds significant and severe enough for “treatment”. This mental health diagnosis will then become a permanent part of your medical record.
Your confidentiality can not be guaranteed.
Despite the careful and ethical practices counselors use to protect your health information, there is no way to stop insurance companies from gaining access to everything about your counseling process. It is routine for insurance companies to call counselors and conduct clinical reviews by phone. And because your counselor is contracted with your insurance company, they need to comply. During these reviews, which can last anywhere from 15-60 minutes, all details must be shared with the insurance reviewer about your counseling process. From the details of what brought you to counseling, to your diagnosis, to progress made, and medications you’re taking. In lieu of these phone reviews, some Insurance companies utilize “record requests”, requesting all progress notes, treatment plans and diagnoses in your clinical record be sent to them to conduct similar case reveiws.
Your sessions may stop being covered by the insurance company at any time.
While the insurance companies state the aforementioned clinical reviews and record requests are to maintain and ensure a quality standard of care is being met by clinicians, the outcome is often times a denial of futher coverage of additional counseling sessions. What this means for you as the client, is that despite what your professional counselor feels is needed to support you, the insurance company can and often does trump that decision and end your right to additional covered sessions.
My hope is that these 3 things you need to know before using your insurance for counseling will help you make a more informed decision about using insurance for counseling. Most counselors have the option of utlizing private pay, which is the only way to bypass the issues with confidentialitiy and continuity of care.
My sincere wish has always been and continues to be the creation of a holistic healthcare system focused on preventative care. One that ensures everyone access to affordable care whenever needed, without profit driven motives from any large organizations or institutions. Let’s hope that together, we realize that vision soon!
