One of the most common questions I get from prospective clients is, “Do you take insurance?”
My answer is “Not Now”.
But, I thought I’d go one step further and help you understand WHY and some of the little knows facts about insurance and mental health counseling.
1. To Use Insurance, You Must Receive A Diagnosis
For your insurance company to pay a counselor, they need to know what’s wrong with you.
In other words, you have to have a mental “illness”.
Currently, the list of mental illnesses come from a book called the DSM-V.
Basically, a counselor will look at all your “symptoms”, match up what is listed in the DSM, and pronounce, “You have Depression (or PTSD) (or Anxiety) (or a Personality Disorder) (or whatever).” That diagnosis is given a number… the number is put on an insurance form… and the form is sent into the insurance company.
Some person somewhere, who has never met you, (or never met me for that matter) will decide if they agree with the “diagnosis” and then decide if they want to pay me to help you overcome your mental illness.
My Response—
Not all problems are mental illnesses.
Depression is a normal part of life. Anxiety is a normal part of life. Confusion, fear, worry, anger, sadness, and bad dreams are all normal.
Sometimes they are more normal if you’ve been through a difficult time in your life, like divorce, job loss, stressful work environments, life transitions, family Christmas, etc…
Reacting with some level of discomfort actually tells me you’re operating in a healthy manner, not as a mental illness.
I don’t want to have to label you as a problem just to get paid.
2. The Insurance Company Often Times Dictates The Treatment
Once you’ve been given a mental illness diagnosis, most insurance companies have a prescribed treatment plan and time frame that they will pay for.
And very little opportunity to deviate from said plan.
So, if you can’t “feel better”or even “get better” within the 6 weeks they say you’re supposed to get better, they won’t pay for it.
My Response—
You are much more complicated than that. No one is made the same or has the same story.
You and I are not widgets coming off an assembly line where one broken part can be replaced when a screw comes loose.
In almost 10 years of experience, I’ve never seen two people move through their problems in exactly the same way.
Yes, there are similarities, but I would like the freedom to create a treatment plan together with YOU, instead of having to have the treatment plans limited by a bureaucratic policy.
3. A Mental Illness Diagnosis Becomes Part Of Your Permanent Medical Record
Mental health counseling is moving more towards a medical model. That’s why there are diagnoses and time frames and prescribed treatments.
What’s also part of the medial model is that all mental healthy diagnosis’ are now part of your PERMANENT mental health record.
That means that, if you use insurance to pay for 6 sessions because you’re depressed while going through a difficult brake up, and you receive a “depression” diagnosis, 10 years from now, while sitting with your doctor, they may ask if you are still taking your depression medication, because obviously you have depression.
That permanent diagnosis for a TEMPORARY experience is going to start defining how you are seen for a very very long time.
My Response—
You are constantly changing.
It is difficult to know that who you were 10 years ago may have such a strong impact on your here-and-now.
I want you to be known for your PRESENT state of mind, not your state of mind when you may have been a very different person.
4. Lack Of Confidentiality
As soon as your mental health diagnosis is put onto an insurance form, there are any number of individuals who have access to your counseling information because they are processing the claim
You most likely are going to counseling BECAUSE you want confidentiality.
Counselors provide a safe and secure place where you can talk about and feel and express things that you normally can’t express to your friends or family.
We offer care and understanding and acceptance—no matter what you’re struggling with.
My Response—
I want to help protect your story.
I don’t want you to have to worry about who is reading your counseling notes or personal information.
I want to continue to provide a safe and accepting environment for you.
5. Insurance Payments Often Times Increase A Counselor’s Fees
Because insurance companies often only pay a portion of the counselor’s fees, a counselor may need to inflate their fees.
Finances can be a major hinderance to getting help. I want to be able to have the freedom to set the rates that make it possible for the most people to be able to get the counseling they need as soon as possible.
6. Bonus Reason—Insurance Companies Don’t Pay For Relationship Problems
Insurance companies really only pay for individual mental health issues.
That means that if you and your spouse come into counseling, one of you has to be mentally ill. (Okay. Quit nudging your spouse.)
Relationships that are struggling can’t be mentally ill, so insurances often times won’t pay for couples counseling… or family therapy… or pre-marital counseling, unless one of the individuals are diagnosed.
Probably half of the work I do in session is helping individuals or couples work on relationship stuff.
They are not mentally ill. Relationships are just hard sometimes.
And sometimes you need a little extra help from an outside perspective.
My Response—
If insurance money is keeping you and your partner from getting the help you need, stop waiting.
The sooner you work on your relationships, the better you’ll feel.
Conclusion
Insurance has an important and necessary function in our society.
I simply want you to understand the realities of using insurance to pay for your next counseling session.
My answer of “Not Now” is just that.
I’m open to accepting insurance when these concerns are adapted or changed so that you, my client, receive more protection, emotionally, personally, and relationally.
Until then, I’ll maintain my “out of pocket” position for the good of my clients.
I hope you understand.
More importantly, I hope I’ve helped to remove one more road block to you making that call you’ve been needing to make to get the help that you need.