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Examine the mask.
Discover the real self underneath.
Choose to be who you truly are.
This journey is our deepest responsibility.
Therapy is an Investment
Making the decision to enter into therapy is a highly personal one. Most people don't make this decision lightly, and they want the best services out there. Your mental health and well-being is a vital part of your total health and the benefits of investing in this are far reaching. Read about my approach and if you believe we may be a good fit, consider making room for this investment if possible.
I do not work with any insurance companies directly, but because I'm a licensed mental health professional, I can provide what is called a "superbill" which is a sort of statement you submit to your insurance company for reimbursement, that that is something they offer. I'll go into more detail about this process below.
Knowing all your options and making an informed decision about your health care and whether or not to use your health benefits is something I myself would not have considered seriously in years past, but knowing what I know now leads me to strongly encourage that you do take the time. You cannot undo any of the negative consequences of using your health benefits.
Consider These Points....
Insurance Requires a Diagnosis
Insurance companies require a diagnosis of mental illness. Not all of the issues we face and seek therapy for fall into the category of a mental health disorder. Being proactive enough to get help BEFORE an issue qualifies as mental illness or continuing therapy even after a mental illness diagnosis has resolved is not supported by most insurance plans, yet this is what really makes therapy beneficial and worthwhile! If you go to therapy when you're in the mist of the worst, darkest place in your life and then stop just after you've begun to make significant changes, you may only be getting treatment for the surface level symptoms, not the underlying issues. Insurance companies don't see it this way - they are looking at what benefits them more so than what benefits you.
Even when you think your insurance company is willing to cover the costs of treatment, there is no guarantee. Every insurance company has a standard line when you call to request benefits info: “A quote for benefits does not guarantee payment…” So while you may be initially told over the phone that something is covered, later once they review the therapist's diagnosis and service codes, it may turn out it's not and payment for the service is then left in your hands.
Insurance won't cover therapy sessions unless you have a mental health diagnosis, such as Major Depressive Disorder, Panic Disorder, or (if you're lucky) Adjustment Disorder. However, do you want a mental health diagnosis on your permanent health record if you don’t need it? What if you just need some support navigating life transitions, grief/loss, or relationship woes? What if you're trying to work through some past issues, but you're still "functioning" for all intents and purposes? Labeling someone with a serious diagnosis who's simply experiencing life as we all know it can be detrimental to the person and to the therapy process.
The Limits of a Diagnosis
When using insurance, your diagnosis (and often treatment notes and other personal information) is shared with an outside party... some "random" person working for your insurance company. You don't get to decide who has access to this info and why - you lose control of that private information by requesting your therapist share it with your insurance. This is a loss of confidentiality, something a therapist is meant to protect with great care. The average insurance claim passes through several different people, which could include potential employers.
Furthermore, a diagnosis only tells a very short and limited story - that there is something "wrong" with you. This can negatively impact your eligibility for other things. When applying for new health insurance, life insurance, and some types of jobs, you may be required to authorize a release of your mental health information to them so they can view your entire medical record. The diagnosis code they will find there doesn't speak to your strengths, your level of resilience, how you cope, and which of the many symptoms you actually have or don't have. While I don't treat children myself, I'd like to point out that this process can and has most negatively affected children who are then followed by their childhood diagnosis into school, college, military, federal jobs, security clearances, aviation, and any other jobs requiring health care checks.
Insurance May Not Cover All Services and Diagnoses
Insurance companies don't cover all services and diagnoses that a therapist can choose from. For instance, most insurance doesn't cover marital counseling. They only cover a partner being present in an individual therapy session, though some won't even cover this. This poses an ethical dilemma for the marriage and family therapist who is actually providing couples therapy, but if they code their service as such, coverage for the couple will be denied.
The diagnoses codes for social/relational issues, work changes/problems, sex counseling, phase of life problems, previous childhood abuse, previous domestic violence, etc are typically rejected. Treatment for these issues is not considered a "medical necessity," similarly to how medical coverage will often refuse to cover what they deem unnecessary or cosmetic in nature such as birth control, acne treatment, or teeth whitening. Typically, what they cover includes Depressive Disorders, Anxiety Disorders, and Bipolar Disorders to name the most common.
You can ask your insurance company if they cover the "V-Codes/Z-Codes" rather than just asking “do you cover mental health counseling?” Be specific, because they will just tell you that they cover whatever you need unless you press them with actual code numbers.
Having Coverage is Not a Guarantee of Coverage
Several processes take place in order for an insurance company to approve treatment. Some companies, even upon approval, will only cover a certain number of sessions per year. They may deny your claim. It may takes months to get reimbursement (if at all). They may say something is covered and later deny coverage, which leaves the therapist having to come to you for reimbursement. Obviously, this nonsense creates added stress for everyone and can slow progress in therapy.
Instead of you and your therapist privately sitting down together on a regular basis to clarify your progress and goals and to decide how much therapy you need, for how long, etc, your insurance company gets to question this decision process at every step and then ultimately decides for you whether or not therapy is helpful and necessary, regardless of you and your therapist's opinion.
If you'd like to request reimbursement with your insurance company, here are some tips on what to ask:
Do you reimburse for out-of-network providers?
What information will I need to present for reimbursement?
How many sessions are covered?
Do I first first need to meet my deductible and is there is an-out-of-pocket max?
Do you require a treatment plan or detailed summary for reimbursement?
Do you reimburse for V-Codes/Z-Codes (such as relational issues or a history of abuse)?
What are the required qualifications of my chosen therapist and what info do you need from the therapist?
You have a choice in what kind of therapist you see and for how long. However, many insurance companies will not give you much of a choice, and they require that your personal information be shared with them in order to process your claims. Once your info has been shared, you cannot take it back, and while many people feel unaffected by this, others have had their lives devastated by it.
Dealing with health insurance can be a nightmare for both the client and the therapist.
Insurance limits your privacy and your access to quality services and treatment.
Insurance will not cover the therapist's full fee, often refuses to pay, and takes twice the effort.
Insurance often limits your choices in therapists, treatment options, and time spent in therapy.
Your wellness is an investment and you deserve a good counselor with whom you connect. It's better to invest now rather than experience greater suffering later on.
"Labels do violence to people.
You can't treat the label; you have to treat the person behind the label.”
(Irvin D. Yalom, Lying on the Couch)