Recently, a man called me looking for psychotherapy and found me listed and approved in an online version of Psychology Today Magazine. After discussing the kind of psychotherapy I do, he asked if I take his insurance? When I answered that I do not take any insurance and provided the reasons why, I told him the much lower fee I charge instead of taking insurance. He immediately became suspicious, told me that when something sounds too good to be true it can’t be true and hung up the phone. I was left with a moment’s feeling as though I was some kind of charlatan. I realized that this had to do with the pathology of the potential patient but, it struck me that he talked himself out of a reasonable, affordable and non intrusive way to receive therapy. For this individual, accepting insurance was some type of measure of competence and honesty. Unfortunately, that is not the case because, while most insurance companies try to screen therapists for licensing and training, there are never guarantees.
This article is based on one written by Nathan Feiles LCSW and can be found at PsychCentral.
Nevertheless, how important should insurance coverage be for someone who is looking for a therapist? In my opinion and in the opinion of Nathan Feiles, LCSW, health insurance should not dictate going or not going to a therapist. The reasons are many because psychotherapy is very different from medical practice. Here are some of the factors that should mitigate against using insurance if possible:
1. There are many well trained and well seasoned therapists who have given up health insurance coverage and they are practitioners, just like myself. With insurance comes all kinds of headaches for the therapist, including hours of paper work justifying the need for treatment. Most individual psychotherapy practitioners do not have a staff to do that work.
2. The fee that therapists get after the patient co-pay does not make it worth doing all that work. So, why do some therapists continue to accept insurance? The reason is that many of them are new and are trying to build both their practices and their reputations.
3. An important issue for anyone in psychotherapy is confidentiality. The fact is that once someone is using their insurance coverage the treatment and reasons for it become part of their file. The file is permanent and, if a patient is applying for a new job and the company wants a release of information to look at medical records, private information becomes much more public. The file includes treatment plan, diagnosis, progress notes and other personal information.
4. Most of these companies only insure for a fixed number of sessions per year and, at that point, the patient has the choice of leaving therapy or paying out of pocket anyway.
5. Therapists are regularly asked to justify the need for continued therapy even when it’s within the fixed number of sessions allowed.
6. Depending on the insurance company or the policy held by the patient, only practitioners within their network are covered, limiting the choice available to the patient. If the patient leaves their job for another and has a different insurance policy, their therapist may be out of their network.
7. Insurance companies follow the medical model which dictates the use of a diagnosis for treatment. While it is true that a diagnosis can be important for certain types of mental illness, it often is not when a patient is trying to solve problems with their mother, husband, sister or friends. That is why many companies will not cover treatment for marriage or couples counseling unless a diagnosis is made available. People have multiple marriage problems without the need for a diagnosis.
If a patient opts against using insurance, can they afford the fees?
The answer depends upon the therapist and his fee structure. Many therapists lower their fees in accordance with what the patient is able to pay out of pocket. The only way to know this is to discuss the fee structure with the therapist. In my opinion and experience, money and fee issues are as much a part of the therapy as everything else.
In addition to negotiating with the therapist, there are alternative options that people now have in the work place. One of these is a flexible spending account. This consists of tax free money that is put into the employees account every month. The money is available to the employee when needed for medical expenses of all types.