I have been in my field of forensics and mental health for over 30 years. Some of my experience was as a Sexual Assault Advocate, Domestic Violence & Anger Management Group Facilitator, Crisis Therapist, Clinical Liaison for a Regional Behavioral Health Authority (RBHA) for the Seriously Mentally Ill (SMI) adult population, a Forensic Mental Health Professional (FMHP) in jails and prisons, and have been a supervisor of over a dozen trauma therapists for 10+ years. I am only telling you this bit of bio information so you can feel confident that I am qualified to tell it like it is. You see, one thing I witnessed consistently was how using insurance to pay for mental health treatment screws the client over in many ways. Therefore I decided to write this blog and, although it is more of an article than a blog post, I am confident you will agree that sharing this knowledge is much more important than length.
However, I am not only writing it to share with you – my blog readers – but also to help educate my agency’s prospective private CG clients who often ask “Why don’t you accept insurance?”
The SHORT answer is “BECAUSE I CARE”.
The LONG technical, “let-me-count-the-reasons” answer is below…
In order for anyone to use their insurance for mental health treatment (or get reimbursed), the therapist is required to diagnose (“label”) them. Why is that an issue? Because most people do not want their “label” to be part of their permanent, official records which follows them everywhere.
CASE: I remember Lora, a 27-year-old Caucasian female who, within a 3-week time-frame was laid-off from her job of 12 years, her car was repossessed, her husband had an affair and moved out, and she lost her home in the 2008 housing crash. In addition she was now facing a divorce and trying to raise a set of 3-year-old twins on her own. When she came into the county’s mental health clinic with an emotional breakdown, she was depressed, her anxiety was uncontrollable, she gave temporary custody of her children to her mother, and she was having suicidal thoughts.
Her employer-paid insurance was still active until the end of the month and, because she had insurance, Jerry (the therapist), “labeled” her Bi-Polar with Adjustment Disorder just so he could bill her insurance (get paid).
While Jerry was doing what he was supposed to do, I personally had an issue with this and ethically disagreed with the process. I mean, who wouldn’t have a breakdown and act “bi-polar” with all that hitting our life at once? Who wouldn’t have a difficult time “adjusting” to all of that?
When the dust settled, and she was reemployed, worked it out with her husband, found a great apartment, and obtained the gift of a car from her parents… she was “normal”. In fact, she had not presented with “bipolar” symptoms of any kind before or after that one instance. But, because it was now “officially” on her permanent record, every provider and insurance company (including life insurance) will be essentially told that she was diagnosed “Bipolar with adjustment disorder” and nobody can remove it.
For the rest of her life this label will follow her everywhere which can affect her eligibility of many things… all because she had a shitty three weeks.
That brings me to…
Now let’s say you wish to use insurance to pay for mental health treatment… because your insurance company is paying for it, they have a legal right to look in your records whenever they want to.
That means any representative of the insurance company will be able to see all of your private information – the traumas, the emotions, the “skeletons in the closet”, and more. In other words, if the insurance company tells the receptionist to audit your file, that $10 / hour receptionist has access to it all. Let’s hope it doesn’t become the topic of her Facebook page.
Then let’s not forget about the others involved in this process… when Jerry submitted Lora’s documentation to the insurance company, others saw the nitty-gritty details too, such as the mail clerk who opens and disperses to the appropriate department, the case manager, the processor, the peer reviewers, the customer service reps, and, if not disposed of properly (and many aren’t), even the cleaning people. In other words, HIPAA does not totally keep your information confidential.
Also, if you ever have to go court like Lora did… divorce, custody hearings, or as a witness, the “legal beagles” have a right to request all of your records and especially mental health records… and they will. Finally, there is not typically a statute of limitations on mental health diagnoses so, once entered into the Medical Information Bureau (MIB) and other systems, it becomes a “pre-existing illness”. My husband sells life insurance, and has for over 20 years. He has seen many people get turned down for situations like Lora’s… even for small policies.
CASE: let me tell you about one of my husband’s most recent clients, Moses. Moses had sought coverage from his Employer Assistance Program (EAP) because his child, age 14, had committed suicide. He was clearly and understandably troubled with grief and yet the insurance company labeled him with “Generalized Anxiety Disorder” and because it was not one of the “covered services” (not a drastic or severe enough label), they would not cover it. Instead, he was slapped with the rejected EAP bill of over $15,000 and a collection agency from hell who was making his life miserable. In fact, one collection agent even told him to pawn his wedding ring to make a payment to them!
Yet still, the label / diagnosis was placed in his permanent record and listed in the MIB, which then caused him to be turned him down for life insurance. BTW – in case you are unaware, everyone who has ever gone to any doctor has a file in the Medical Information Bureau.
That brings me to…
* Even if your therapist highly recommends a 6-month program and you agree… if the insurance company representative (yes, even the receptionist) decides you only need a 2-month program, that is all you will get… unless you pay out of pocket. The only hope here is that the insurance company can be convinced that the 6-month program is medically -necessary (unfortunately that usually takes a small miracle or act of Congress to do).
That brings me to…
Even if the insurance company approves the 6-month regimen, they will rarely pay the full amount and you will be surprise-attacked when the mailman delivers a multi-thousand dollar bill.
So… be prepared to fight for it because insurance companies have often told mental health clients that something is covered and then, after they receive the treatment, the insurance company denies it anyway. This can interrupt your treatment and impact your credit, bank account, stress levels, emotions, and much more, even undoing the very things you sought treatment for. So… what are your options or choices?
Pay cash for your sessions to assure that your records are completely confidential. You can then have the amount of treatment that is best for you and your future.
If you cannot afford your payments, there are agencies who offer sliding-fee scales and payment plans.
If you must use insurance, try to avoid in-network providers and, instead try to use a PPO so you can pre-pay and then get reimbursed, which will help just a little bit with confidentiality and the other points above. Again… just a little bit.
However, be advised that many insurance companies will not give you a choice when it comes to which therapist you choose. This has it’s separate drawbacks too such as compatibility, ability to trust and build rapport with your therapist, etc. I mean, ever met someone you instinctively-for-no-obvious-reason didn’t particularly like? That happens with therapists too. If you don’t jive with your therapist, the outcome of your treatment will be disappointing.
Added bonus for self-pay: many times paying out of pocket can be tax deductible.
From a professional viewpoint… most quality therapists rarely take insurance. Okay, I am not saying that there are NO good therapists or psychologists out there who do take insurance – there are. However, when comparing supply & demand, only those who are busy (which equates to successful in this case) will not accept insurance.
Why? Because with all the headache of paperwork, submitting billings, arguing with insurance companies on your behalf, filling out more paperwork, resubmitting billings, etc…. for an average of 7-10 extra hours per month behind the scenes perclient, this results in your therapist making minimum wage.
Typically only those who need the clients will sign up for all of that hassle, even though they know that doing so is usually not in their client’s best interest! Therapists who are not full of clients will be happy to jump through the red tape just to make some money and get their name out there. However, once they are busy, almost always they will stop accepting insurance.
How do I know? Because when I started out, that was me.
I needed the clients and was going to accept insurance. I was willing to stay up all day / night for a week to get all pre-client requirements done but...
That’s not all…
Many insurance companies will not accept new providers (therapists) and, even if they do, they rarely pay anything. The amount they do pay equals 40% of the total cost on average and again – to get that 40% payment, therapists have to spend 7 – 10 extra hours behind-the-scenes fighting for their money. That takes time away from serving clients (the very reason we went into the career field).
So hopefully you can see that insurance is beneficial for your cell phone, pets, physical health, your home and business, your car, and your life… but not so much for your mind.
One final piece of advice… creating any kind of change in your life requires a commitment.. an action step of some kind. When you pay for your own therapy out of pocket (action step), you are more committed to following-through because you have more to lose if you don’t.
This is a great way to hold yourself accountable.
Looking for evidence-based, home-based and powerful therapy (without meds, diagnosis, and testing) and with affordable cost and payment plan options?
If so, you are in the right place and can start right now.
In fact, even the famous psychiatrist Daniel Amen verifies why we have said since 1987 that “talk therapy” is not the way to life-changing transformation nor are “psych meds”…. watch his video below.
No matter what you decide, it is important to know the above so you can make an informed decision when it comes to your short-term and long-term mental health goals. Equally important is how using insurance for your therapy can affect you when you want to purchase items or receive services that are not related to mental health.
Please understand that other types of insurance is very valuable. In fact, if you are an employer who cares, or have loved ones you’d like to protect for future generations, my husband can help you with that.