“WHY don’t you take insurance?”

There are a few reasons why I chose to not directly accept or bill insurance. Some of those may also be the reason for you to reconsider attempting to use your insurance for counseling.

Identifying the Client

When it comes to insurance, there can only be one client. For an individual client, this may not be much of an issue but for couples or families, this can be a problem. It means that I have to identify someone as “the client,” the one with the problem. Only that one person is listed on the insurance claim. The other person, or members of the family, are there as “support people.”

Couple or family issues are not always created by one person in the pair or group. The best method to address these issues is together, rather than focusing on one individual. Couples or family therapy is successful when each person owns their contribution to the issue that is affecting the group as a whole. When one person is identified as having the problem, they are often seen as the sole reason for the bigger issue, and that gets in the way of solving the problem.

Medical Necessity

Insurance companies only pay for what they see as “medically necessary.” What this means, is that your mental health issue is severe enough that it affects the way you function at work, school, in social situations, or activities of daily living (bathing, eating, etc.). If I billed your insurance, I would need to justify to them why your diagnosis prevents you from being a functional individual.

Not all clients have a mental health disorder. Many seek therapy before their issues worsen or it before their issue meets the criteria for a mental health disorder. Insurance companies don’t often understand being proactive, but instead penalize clients for not having a “medically necessary issue.”

Insurance billing is even more complicated with couples or families. Most insurance policies don’t cover this type of therapy. It is diagnosed as a Z-Code, which indicates issues that may come up in therapy don’t qualify as a mental health diagnosis. When an insurer sees this code, they simply reject the claim. Some therapists will bill insurance for couples counseling by diagnosing the “identified patient” with a mental health diagnosis. The problem with this is if they then do marriage therapy, they are not actually treating the diagnosis that is being billed for. This does not fit with my ethical standards.

The Impact of a Diagnosis

The other issue with insurance requiring a diagnosis is that you now have one. Having a diagnosis can get in the way of successful therapy. Some clients accept their diagnosis as “who they are”. For example, one might think “I am depressed” instead of “I have depression.” I see my clients as complete people who are struggling, not as a diagnosis. I want my clients to see themselves that way as well.

Once a diagnosis is reported to the insurance company, it will remain on your medical records for the rest of your life. Many people don’t realize how that can impact them and how they lose control of who has access to that information. That information is shared with those who need access to it. Your diagnosis will be available to any employer who requires health-care checks. The diagnosis may have been given to you years ago, but it can negatively impact you forever. A diagnosis does not explain changes you have made or improvement in functioning. It simply names a problem you had.

Your right to decide who knows your diagnosis is gone once that diagnosis is provided to your insurance.

Insurance companies require clinicians to reveal diagnoses, symptoms, behaviors, and treatment plans that itemize the issues we are working on and the goals we have set. I am not willing to reveal confidential, potentially damaging information to an insurance company to justify my clients’ needs for emotional support. Protecting the confidentiality of my clients if important to me. Avoiding interactions with insurance companies helps me accomplish that. 

The decision on length of treatment, what method and approach used is a decision you and I make together. Insurance companies limit how many sessions they will pay for.

Insurance and Me

I want to be transparent here. I want to spend my time helping clients. Accepting insurance demands a lot of time. I want to spend my time providing therapy rather than completing insurance paperwork.

Is There a Way to See You and Use My Insurance?

In cases where an insurance company will reimburse for out of network mental health services, but it varies from plan to plan. You will want to check with your insurance companies for the specific details. I can create a “super bill” which itemizes the services you received, how much you paid and your diagnosis, however the concerns I listed above about privacy, diagnosis and medical records still apply.

One Final Note

Entering therapy is a hard decision. I don’t want the cost to deter you. You are investing in yourself and your relationships. Connecting with a therapist you trust is important. Addressing issues early can help prevent bigger issue later in life.