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PROS AND CONS OF USING INSURANCE TO PAY FOR MENTAL HEALTH THERAPY

With the recent implementation of surprise billing protection and good faith estimates for consumers with regard to health care, I thought some information on the pros and cons of using health insurance to pay for therapy would be appropriate. Read on for more information.

Life is getting difficult and you've tried many things to cope with the struggle. You want to feel better, or help your child feel better, but nothing seems to be making a difference.

This is the point when many people decide to seek help from a counselor. One of the questions you might ask during an initial consultation or phone call is does the counselor you're interested in seeing accept insurance. Maybe you're also wondering if you should use your health insurance to pay for counseling services.

First, to clarify, I do not accept insurance presently for various reasons. I do have many clients ask me about health insurance during initial phone consultations. Since health care, insurance and benefits are confusing topics, I decided to write a post as a resource for folks trying to decide if they should use their health insurance for counseling.

In this post, I will talk about the pros and cons of using your health insurance for counseling.

Cons for using health insurance for counseling:

Diagnosis

If you use your health insurance for your therapy, the counselor is required to give you a mental health diagnosis. Without a diagnosis, there is no basis to establish medical necessity for receiving treatment. This is problematic for individuals that are going through a tough time and just need some support from a professional. If you want to use insurance, the counselor is required to give you a mental health diagnosis.

Diagnoses pose special considerations for couples seeking therapy. In couples therapy, counselors must identify one of the adults as the primary client and assign that person in the couple a mental health diagnosis. This is the only way to present the couples therapy as supportive therapy to the primary client's diagnosis and treatment plan. Confidentiality also needs to be considered in this case of couples therapy. The primary client in the couple is assigned a diagnosis that becomes part of the permanent medical record.

Confidentiality

When you use your insurance to pay for therapy, your mental health care information is not private. Your insurance company can access your medical records and review your diagnosis and treatment. Your diagnosis and treatment are part of your permanent medical record. This becomes important when you are applying for insurance, jobs (i.e. pilots, military, police officers) or encounter other situations where questions are asked about your mental health. You will be required to disclose that you received treatment for a diagnosis that you were given since this information is part of your permanent medical record.

Number of Sessions

Some health insurance companies have limits on the number of sessions they will cover for mental health care. These limits can vary and can be limited to as few as 4 sessions. Most people who present to counseling will need treatment/support that extends beyond 4 sessions.

Even if the insurance company doesn't have a predetermined limit to the number of sessions, they can make a decision that you are "improving" and determine that therapy is no longer needed because of the information in your clinical record.

Now, on the other side, the benefit...

Pro (yes, this is intentionally singular) of using your health insurance for counseling

Out of Pocket Cost

The obvious benefit to using your insurance is that it can lower the cost that you are paying out-of-pocket for services. If you choose to see a counselor that is a preferred provider for your insurance company, your cost per session out-of-pocket may range from $0 to $60 per visit. The cost is dependent on your benefits and other factors. Counseling in Colorado can sometimes range from $100 to $200 per session. Using insurance and paying less out-of-pocket is an obvious financial benefit.

Using (or not using) your health insurance for mental health is a personal decision and comes down to what is important to you as an individual. If keeping cost down is a primary goal, using your health insurance can be of great benefit. If your goal is to have more control over your confidentiality and the number of sessions that YOU might need vs. what the insurance company deems to be appropriate, then paying out-of-pocket might fit your needs and be of greater benefit to you.

It is a decision that deserves careful consideration of pros/cons and your needs as you enter into your journey towards better self-care and mental health.