What you should know about using insurance to pay for therapy
Real talk, mental health care is expensive. It shouldn’t be. It really shouldn’t. But it is. It sucks. It sucks for those looking for care, and well as those trying to provide it. (By the way, therapists also have therapists, so I feel the pain too). There is a whole worthwhile and complex conversation about the converging influences of capitalism, the recognition of mental health as a right, etc - but the present reality is that mental health care is expensive.
Most of us feel like we’re already paying an arm and a leg for our mandatory health insurance, so that should cover mental health care as well, right? Well, yes, it should, but it often does not. Or it does, but there are some “hidden strings” attached that anyone using insurance to pay for therapy should be aware of.
You, as the consumer, and the insured, should be aware of these strings so that you can make an informed decision. This is part of informed consent in the client-therapist relationship. Here are some of those strings.
To get insurance companies to agree pay for your treatment, you need to meet what they call “medical necessity”, and that means I have diagnose you with a documented diagnosis. Without that diagnosis, even if I am “in network”, many/most insurance providers will not pay for therapy for preventative care or personal improvement. They need a mental illness diagnosis, or they will most likely deny the claim. What that means is that you will have a pre-existing mental health condition on your permanent medical record. There is no statue of limitations for mental health conditions, so this diagnosis is on your record permanently, even once resolved. This can (does not always, but can) have long-term consequences of making health, disability, and life insurance more expensive and more difficult to obtain for you, and potentially your family, in the future. It may result in you only qualifying for limited coverage and high(er) deductible plans with high copays. The future is uncertain about this as healthcare laws are in a continuous state of change, but it is something to be aware of.
You lose control over the confidentiality of your information: As mentioned, a mental health diagnosis goes on your permanent medical record. Generally speaking, the details of the content of your therapy sessions are safe, except in extreme circumstances, but the insurance companies do require enough information to justify the diagnosis of why they are paying for treatment. This record can be accessed by the government and by other insurance companies during certain kinds of background checks. This can affect things like security clearances, joining the military, applying for certain kinds of jobs with background check requirements, can also affect workers comp cases, and a variety of other circumstances. While it requires a subpoena, if you're ever sued, or in a divorce or custody battle, these records can be requested and used in order to build a case against you. This outcomes are not always true, but they are possible, so it is important to be aware of the risks.
The information listed here is public domain and I encourage you to do your own research and validate and verify these things so that you can make an informed decision. Some of these considerations may not affect you, or may already affect you, and so may not be relevant.
Another thing to consider is that you may be more likely to be committed to a process that you are paying for. Consider the old saying, “that which is free has no value”. While therapy is expensive, the cost of a session may work as supportive motivation to increase commitment and openness to change as well as the process of practice required to see those changes take root. It can help you to take it more seriously.
It can be helpful to frame therapy as an investment in yourself, and an active investment may be more likely to pay out in desired goals than a passive one. As a therapist, my goal is to get you feeling better and get you off my patient list as quickly as reasonably possible. This is why I try to keep treatment my initial treatment plans are written to a six-month time frame, even if that is not always possible.
As always, I am more than happy to discuss any of this information at more length. Please reach out or leave a post so I can respond to help with clarity.
Be well,
-Ryan
