One of the questions I’m often asked by potential clients is, “Do you take insurance?” I mean, you pay for health insurance for a reason and you want to use it when you can, right? While I don’t participate in direct billing with insurance companies, there are many insurance policies that will reimburse for treatment you’ve received. These are generally known as Preferred Provider Organizations (PPO) or Point of Service (POS). If you have one of these policies, you could process a claim (generally online) and receive reimbursement for all or part of what you’ve paid.  Please keep in mind, most insurance companies will require you to get a pre-authorization for what they call Out-of-Network-Treatment, so you’d need to call them first. Going out of network is a normal process for most PPO’s and POS’s, which are more flexible by design. If you have a HMO or an EPO they will have more restrictions, but call them to confirm. In California there is a recent law that states PPO’s and POS plans must pay for any licensed provider, so if you have one of those plans you’d be able to get your sessions paid for using your health coverage. Also, if you have an Health Savings Account (HSA) you can also you that to pay for sessions. They work much like an ATM card to cover your counseling sessions. So, even though I don’t participate in direct billing, in many cases you should get some of all of your visits covered.

So why don’t I bill insurance companies directly for my clients?

I’m glad you asked. There are really two reasons why I don’t participate in direct insurance billing. The first is working with insurance companies has become increasingly difficult for several reasons. (None of which we have time to cover here…believe me.) The second reason and the more important is for the sake of my clients. So, how is not taking insurance helping my clients? That a great question and one which will take a little time to unpack but suffice it to say, it’s really about protecting your confidentiality and personal information now and in the future – I want to protect the privacy of what’s inside your head!

Now, I don’t believe in black helicopters flying around tracking us or that the NASA moon landing was a hoax, but that doesn’t mean someday the information you provide can’t or won’t negatively affect your life in some way. Information is power, so I encourage you to review your options and to become fully informed as to the risks and benefits before you use your insurance to pay for mental health services.

5 Reasons You May Not Want to Use Your Insurance to Cover Your Mental Health Treatments

#1. Insurance companies require a) a diagnosis, b) a treatment plan, & c) access to your file. 

In order to use your insurance, your provider will require some or all the following three items. First, you’ll need to be diagnosed with a legitimate mental illness or disorder. Insurance companies aren’t in the business of paying for things that aren’t a medical necessity. They don’t pay for plastic surgery or other things they consider non-essential procedures. This means they don’t pay for issues like “I’m having a hard time,” or “I’m grieving a loss,” rather they’ll only pay for a diagnosed mental disorder such as depression, anxiety, etc.

The second thing they may ask for is a treatment plan with measurable goals and objectives to track your progress. The third item they may ask for is notes from your therapist file to review your progress. While therapists generally do their best to limit the amount of personal information they document in your record, it’s unethical for them to not give the complete therapeutic picture of your case. Meaning, some of the aspects you talk about in counseling will need to be disclosed to them.

Most people who come to therapy are dealing with everyday life issues rather than what would be considered a true mental illness or even a disorder. If they want to use their insurance, with the exceptions of a few limited cases, there isn’t any preventive medical coverage for counseling like there is for annual checkups with your primary care physician. You have to be sick for them to pay for your treatment.

#2. Insurance companies can limit sessions and/or treatment methods.

If you are using your insurance, your carrier may limit the number of sessions and intervals they will cover. This generally isn’t a problem if you can keep your visits to fewer than 12 sessions. While this is more rare these days, but it can still sometimes happen. Every company is different but before you use your insurance you confirm the number of session.

If you’re not directly limited to the number of session your case may need to be reviewed from time to time. This is most often done with a case update or a recorded phone interview with the insurance company updating them on your progress. This recording would also be included as part of your medical record. In addition to limiting your sessions, your insurance company may limit your treatment to what is known as ‘Evidence Based Treatments’, meaning they may not cover counseling modalities they don’t deem as valid treatment such as couples counseling, family counseling, or even Christian counseling.

#3. Your treatments will become a pre-existing condition in your medical record.  

If you use your insurance to cover a mental health treatment issue, your claim will become a pre existing condition, which will then be a part of your medical record. Many don’t see any problems with this. But, given the changing political climate we all live in, you never know how this may impact your future life. I have a friend whose daughter tried to enlist in the military only to be denied because her medical history indicated she had been treated for depression 24 month earlier. I also know of a person who was involved in major vehicle accident and later sought legal relief for his injuries only to have his medical record reflect he had a pre-existing mental issue. This sadly contributed to his case being lost. While the likelihood this would ever happen is rare, nevertheless, the possibility of something coming back to haunt you is still there.

#4. Your personal information will be available for others to access and see. 

The Healthcare Information Portability and Accountability Act (HIPAA) that passed back in 1996 was promoted as providing new protection of our sensitive medical information. While it’s true the law did in fact address several issues and made it a federal crime to unlawfully disclose someone’s private medical information, it also made accessibility to that information more available to others. In the old days, your Personal Medical Information (PMI) was kept on paper in your provider’s office. Today, it’s kept in electronic databases where countless people can have access. Having access to someone’s immunization record or their last physical is one thing, but having your thoughts, feelings, and personal struggles available for others to review, abuse, – or worse – sell on the black market, is entirely different. A recent ABC story details what can happen when your personal medical information falls into the hands of the wrong people.

#5. How will your medical information be used in the future?

Nobody really knows the answer to that. We are living in an ever changing world, and we don’t know for certain what the future really holds for us – let alone what our healthcare system will look like 5, 10, or 15 years from now. Our current laws give you protection, but they can be rewritten with uncertain outcomes. The first draft of the HIPAA Law had around 350 words related to the protection of your medical information. Today those 350 words have become over 500 pages – highlighting the fluidity and changing nature of these laws. While no one can tell you your personal medical information would ever be used against you – neither can anyone tell you it won’t.

Some Closing Thoughts

So what’s the solution for those who either want to or need to use their insurance? Well, you can go ahead and use your insurance and chances are you’ll never have a negative problem.

If money is the problem, there are some other options. Many therapists, including myself, offer a sliding scale based on a client’s ability to pay. This, combined with a payment plan, can go a long way in making mental health care within the reach of most people’s budgets. For those interested in this option, I would invite you to contact me directly. There are also low-cost counseling options that utilize counseling associates, who are trainees and interns earning the 3,000 hours they need before they can sit for their state license. These are registered associates who have their Masters Degree and are supervised by a licensed therapist. The prices for their services can be up to half the cost of a fully licensed therapist. If you’re interested, my resource page has a list of some local Christian counseling centers here in the Sacramento area.

Another option is to see if your employer offers an Employee Assistance Program (EAP) to cover any of your counseling. If so, they will generally cover up to six sessions and won’t require you to be diagnosed or need a treatment plan. They generally aren’t as intrusive as your medical insurance, but they can still request information as to the nature of your issue. In some rare cases, this has the potential of being reported to your HR department within your organization.

Whichever way you decide to go, there are options to get the help you need. Please don’t ever let your fear of using your insurance keep you from using it if it’s your only option. If after looking over your options, you decide using your medical insurance is your best option, then by all means go ahead. The purpose of this article is not to scare you, but to inform you – something I hope I have accomplished. In the end you’re far better getting the help you need than going without care. Here’s to wishing the best in your search for your own mended life!

-Joel Walton