What are the Pros & Cons of Using Insurance for Therapy?

“She has Clinical Depression.”
“He has Bipolar disorder.”
“My child has an Adjustment disorder.”
“I have a Personality disorder.”

Is there anything wrong with accepting the mental health diagnoses of a psychiatrist, family doctor, or therapist? For some people, a diagnosis offers important information about their condition and helps them to make sense of challenging life experiences. They also provide a key to what psychiatric drug they may need. For others, predefined labels seem too simplistic and negative when defining complex individuals who each have very different needs and life histories.

Whether you are in the camp that finds diagnosis practical and helpful, or you think diagnosis is less important than seeking out ideas for change, this article provides some of the pros and cons to consider before using your insurance to pay for counseling and psychotherapy.

The Pros of Using Insurance
Using insurance for mental health and medical procedures makes financial sense. Insurance products such as HMO’s and PPO’s have high premiums, and since these costs are often taken directly from your earnings, why not use this benefit? The obvious advantage of using insurance is that your company will pay for therapy expenses with a co-payment, deductible or both, paid directly to your therapist. Some insurance policies may cover all of the expense of therapy at no additional cost to you. Most insurance companies allow their subscribers a certain number of therapy sessions per calendar year. Additional sessions may be requested from insurance by your therapist through a “pre-authorization” request.

The Cons of Using Insurance
Therapy can be helpful in many situations, from personal growth to couples counseling to help adjusting to psychological challenges. As a result, many people seeking therapy may be coming for something other than help with an identified mental health diagnosis. But, insurance companies will only authorize services that they approve as “medically necessary”. That means your therapist must provide your insurance carrier with a mental health diagnosis. Insurance companies determine the length and frequency of your therapy depending on this diagnosis. 
  
Insurance Compromises Confidentiality

• When a therapist provides an insurance company with a bill the employees of the insurance company, e.g., the bill processor, case manager and customer services representative handling your claim, have access to your mental health information.
• Once a diagnosis enters the insurance system, it is there for a long time. This can impact you if you apply for private life or disability insurance. It may also be requested for review as part of certain job applications such as law enforcement or FAA licensure. 
• To receive couples or family therapy, one member must receive a diagnosis.
• If you are involved in a court proceeding such as a divorce or a custody hearing your behavioral health records may be subpoenaed and reviewed by a judge.
  
• Information that may be requested as part of an insurance companies audit includes, but is not limited to, your initial evaluation, diagnostic information and prognosis, treatment plans and goals, dates and times of each session, session notes, treatment reviews, and collateral contacts.
  
  

So, how do you choose what's best for you?
Before entering therapy consider the pros and cons of using your insurance to cover the cost of treatment. Ask yourself if you are OK with compromised confidentiality? Consider whether or not it is important for you to decide how long you are in therapy, or if you are OK with a third party making this decision for you? Ask yourself if you can afford to pay for therapy on your own, or if you want to pay for therapy on your own?

There are a lot of points to consider before making your decision. Only you can determine what is right for you and what you hope to gain when entering a therapeutic relationship.


-Learn more about WVC Therapist, Appointments and Counseling Fees.

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