Never Use Insurance for Mental Health Treatment. Here’s Why…

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 pocketThe 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. 

amenThis is why the CG program is successful & uniquely tailored for each of our thousands of worldwide clients… and has been since 1987.

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.

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Post by Ms. Mozelle Martin

Disconnecting from Toxic Family Members

A common goal of my clients at the beginning of every new year is “Disconnecting from Toxic Family Members”.

Here is my advice for them:

TOXIC PEOPLE ARE NOT FIXABLE SO DON’T TRY. The way toxic people act is because of an internal struggle they bear inside of themselves but is taken out on those around them, or their target.

It is not your place to “fix” them, and they often have no idea why they feel the way they do, do the things they do, and hurt the people they hurt. Yet, they continue to do it; this in no way makes what they do justifiable.

There are also those toxic people with personality disorders who understand what their heinous words and actions do to others, but find their behavior defensible. Of course, it never really is, but in their minds they will always find a way to justify the means.

Toxic individuals are aware of the chaos they create around them. Some do so intentionally, others may be good people who do not know how to exist in the world without forcing others (you) to compromise their (your) happiness to their infliction.

Toxic people create drama and live in a world of negativity. They are essentially addicted to the drama – the negativity – the toxicity. When life is calm, it is disorienting so it doesn’t last long. Creating an argument, or turning a tiny issue into a huge verbal battle, is sure to bring their unhappy world and mindset right back. SO, take a hard look and decide for yourself if you can tolerate their behavior for a lifetime – because it will likely never go away… OR if its time to make your own well-being a priority.

This may mean that you distance yourself from this person by spending less time with them, not sharing personal information, or disconnecting entirely – temporarily or permanently.

YOU HAVE A RIGHT TO CREATE A HEALTHY (& HAPPY) LIFE FOR YOURSELF and there will come a time when you say, “enough is enough.” You are a person who deserves to be treated with love and respect. You cannot possibly grow if the sunshine is always being snuffed out by a raging storm.

You will not love yourself or live a positive, flourishing life – a life you absolutely deserve – in the wake of a toxic person who purposefully hurts you and keeps you from true happiness.

TAKE A LOOK AT WHAT YOU ALLOW: these toxic individuals often manipulate, lie, are passive-aggressive, hurtful, or physically abusive, yet continue to act this way because you allow it in your life.

What are you doing to stand up for yourself and to stop the way they treat you? How do you react when they disrespect and hurt you? What is the toxic person’s reaction when you choose to stand up to them? When you confront a toxic person, do not expect it to go smoothly. 

Because they often take your distance as a personal attack, an insult if you will, or rejection, you will often see manipulation at it’s finest. A family member will often play the victim and try to corral other family members against you because they feel you have hurt them. They may use their emotions to influence other family members and isolate you, and they may treat you harshly in return. It is common to expect lies, victim stories with you being the “bad guy”.

Toxic people will often flat out lie about what you have gone through and why you are disconnecting from them. They will usually make up new stories to disarm your interpretation of the truth and will seek to redirect the indictments they feel you are accusing them of. Again, to make them appear to be the victim.

The things the toxic person says, what those around her will say to you and accuse you of may make you feel like the crazy person. Know that the redirection is just another manipulation to make you question the validity of your claims, recollection of your account of events, and even question your own emotions. You may even feel that you are crazy, overreacting, or dramatic.

Do not question yourself. You have every right to stand up for your well-being, for your emotions, and for your sanity. It does not matter if it’s a family member or a friend, you do not have to tolerate toxic behavior when it affects your well being.

NO KIND OF ABUSE IS EVER TOLERABLE. Anyone who physically hurts another is likely breaking the law and there are consequences for their actions. If someone if emotionally manipulating, bullying and abusing you, know that you deserve better and that it’s OK to let go and walk away – whether from your parents, siblings, adult children, or another family member

No amount of love, forgiveness, guilt, grief or prayer will fix a person who is broken and purposefully hurting another (you) because of the rush they get from inflicting chaos and pain. The person you need to save is yourself.

Practicing self-love and self-care every day will feel like a new concept, but over time, you week see and feel it was the right step towards a new and fulfilling life.

The time it takes to heal from walking away from a toxic person may be swift but other times, it can take years and cycles of anger, grief, sadness, relief and finally contentment. The human mind likes to know “why” but trying to find the ‘why’ to the actions of a toxic person is usually a fruitless journey. It is one you will inevitably try to figure out for yourself, but in order to let go, you must be okay in likely never knowing those answers. Don’t give your personal power to trying to figure it out, that only serves to prevent the healing of your “scars”.

They have no justification for the way they are and the things they do and cope with the fact you aren’t like them. Are you prepared to let go – temporarily or permanently – and are you prepared for the fallout from potentially other family members or friends? How do you know when to walk away from family? Are you ready to start letting go of family?

Will you be able to continue to remind yourself that YOU are valuable when you are cycling through the stages of letting go? When you feel like giving in and picking up (or answering) your phone, can you be strong enough to know that the journey is long and hard, and each time you want to give in, it WILL get easier?

The way you feel is important and, if this is the journey you choose to take and in all the loneliness and heartbreak of it, know that you are not alone – there is support. More importantly, there are so many people like you who have chosen to be incredibly brave and embark on the path of their own happiness, just like you.

TOP 7 REASONS PEOPLE TERMINATE RELATIONSHIPS WITH FAMILY MEMBERS:

1). When the relationship is based in any kind of abuse, mentally, physically, sexually, verbally or emotionally. When the relationship is based in manipulation, overt or covert, you can be sure you are being used and abused. When you are living in constant anxiety never knowing or being able to predict how any engagement is going to turn out, it is time to love yourself enough to let go.

2). When the only contact you have with them is negative. The contact you have with them serves to bring you down, put you down and/or make you feel you are not good enough, or you haven’t done enough for them.

3). When the relationship creates so much stress that it affects the important areas of your life at work, home or both. When your emotions are totally caught up in defending yourself and wanting to explain yourself, and the chaos of your relationships with these people is all you talk about, it is time to let go.

4). If you find yourself trying to right the wrong’s (gossip they told about you), and you are constantly being ostracized to the point you lose sleep over it, you have been poisoned with their toxicity. Gossip only serves one family member, the one telling it. Yet you can be left feeling defenseless against the false beliefs about yourself. There is usually a ring leader gathering the troops for the assault and because they are joined together, you begin to wonder whether it is you who has or is the problem.

5). When the relationship is completely all about the other person and there is no real reason why the other person cannot make any effort toward the health and maintenance of the relationship with you. One sided relationships are set up for your failure. When you realize there is never going to be an “enough” place for you to reach in the relationship, you need to let go and start to focus on your own healing. Remember you should never be more invested in someone’s life than they are.

6). When and whether the relationship is only about borrowing, or needing money.

7). When crazy-making, no-win games dominate the relationship (ie: silent treatment, blame-games, no-win arguments that spin around on you), there is no point in continuing in this battle. Verbal warfare is never the place you will convince them of anything and these kinds of verbal interactions are set up to be their way or the highway.

One CLASSIC sign of a conversation or piece of advice going nowhere is when your well-intended help is met with “Yeah, but…”. 

10 SIGNS YOU HAVE A TOXIC FAMILY MEMBER:

1). You Feel Sad And Down Around Them

2). You Feel Angry Around Them

3). You Don’t Want To Go See Them

4). You Find Yourself Having To Take Care Of Them

5). You Feel Drained Around Them

6). You Feel Numb Around Them

7). You Can’t Say Anything Right Around Them

8). You Feel Forced To Be Around Them

9). You Feel Unlike Yourself Around Them

10). You Feel Like They Control The Relationship

Unlike healthy relationships, which have highs and lows, and struggles now and then, a toxic relationship is poison to the people involved. The excuse of “being blood” or “being family” is no excuse. Families should be safe havens for the people within them, a shelter of love, hope, support, and affection in a vast world.

** BENEFITS OF LOW OR NO CONTACT? **

Aside from no longer putting yourself in the path of constant maltreatment, you will likely enjoy:

~~ A sense of peace (all the jitters of constantly expecting an emotional ambush will be gone.)
~~ A sense of empowerment (for the first time, you may be protecting yourself.)
~~ A sense of being a real grown-up (no longer having your life dictated by anyone else (ie: toxic parents)
~~ Freedom (to make your own choices)
~~ Holidays you can enjoy (without the drama, the demands, the painful interactions)
~~ A sense of being more authentically “you”
~~ A better use of time (in doing what you want)
~~ Growing more comfortable in your skin
~~ Discovering new facets of your personality which were buried under the toxicity.
~~ New fulfilling relationships with emotionally healthy people
~~ Joy in being untethered (emotionally)
~~ A voice that speaks the truth
~~ A voice that says what you don’t like, what you do, what hurts you, what gives you joy—all without fear of repercussions
~~ A better view of the world (and less feeling like the world is going to ambush you with its demands, pains, and abuse)

Some of these benefits will come immediately from putting a halt to the toxic relationships while other benefits, such as finding one’s voice and living without a notion of guilt, may take time and even therapy…

People who come out of deeply toxic relationships often have a form of PTSD, so the movement from feeling run over and emotionally exhausted to feeling happy can take time, patience, and support. Be sure not to rush it and to nuture yourself.

BOTTOM LINE? Choose You. Choose Happiness and Peace. Choose Your Emotional Well-Being.

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Post by Ms. Mozelle Martin