About Health Insurance

I am a therapist because I enjoy helping people. However, it is also the way I make a living. Professional relationships work best when client and professional have a shared understanding about financial issues.

For the past twenty years, most people have partly funded therapy with health insurance. It was a system that worked reasonably well, but it has changed. I no longer participate in any health insurance networks, and payment for our sessions is due on the day you receive service. However, I will be willing to file insurance as a convenience to you, so you can receive reimbursement. Please consider the benefits and drawbacks to using health insurance for our visits. 


Benefits of Using Health Insurance

The primary benefit is clear. You paid premiums for health insurance, either directly or indirectly through your employer. It was an investment. One return on that investment is reimbursement for part of your therapy bill.


Court and Custody Cases

We do not usually take insurance for court and custody cases. The reasons are multifold. Primarily, most children and families going through a divorce do not meet diagnostic criteria for a clinical diagnosis to file with insurance. In addition, even when some people have those diagnoses, they are not the primary focus of treatment. Often, I am asked about an adjustment disorder. While it is true that divorce and separation is an adjustment, the individual or family receiving therapy may not meet the criteria for a disorder. There are some therapists who do not view cases this way, however, I do not feel it is legal or ethical to assign a diagnosis where one does not exist or is not being the primary focus of treatment. Please read the effects of doing so below.

Complications of Using Health Insurance Benefits

Problems come in three areas: loss of confidentiality, loss of control of treatment, and the effects of having a psychiatric diagnosis.

 (1) Increasing Loss of Confidentiality: In the past, therapists only needed to provide insurance companies with a diagnostic code, identifying information, and dates of service. Now insurers usually want a thorough description of your problems, history, symptoms, family life, work life and so on. This information may be reviewed by employees of both the insurance company and a separate managed care company. Many employees of these companies do not have the same training in confidentiality as professionals. Unfortunately, there have been increasing reports of disturbing breaches of privacy, and I have no control over confidentiality procedures once the information leaves my office. Insurance and managed care companies put your information into their computers. Managed care company ownership has been changing rapidly. Smaller companies are bought by bigger ones, which are swallowed by even bigger ones. Therapists are concerned about what will happen to client information as changes in ownership take place. Decreases in privacy may lead to decreases in your openness. The more that is true, the less effective our work together is

(2) Loss of Control of Treatment: Managed care companies use the information we must provide to decide if treatment is medically necessary in the first place, and, later, if it should continue. Many who make these decisions have limited training in psychotherapy. Managed care companies make money by reducing how much treatment occurs. Therapists worry that economic goals may color their decisions. In other words, the criteria they use may be quite different from those you and your therapist use. Reviewers have formulas they must follow in making decisions. Some formulas are economic. Others are based on “average” cases. However, formulas and averages cannot account for human individuality. Therapy done by formulas cannot provide the careful listening that years of scientific research have shown to be the cornerstone of effective therapy. Therapists who belong to some managed care panels are pressured to follow formulas or lose membership on those panels. The two people who can best make treatment decisions are the client and therapist, in partnership. It used to work that way. Today, if you depend upon health insurance benefits, it may not. Control over treatment is also lost because some kinds of services and problems are not covered. For example, marital counseling is usually not covered even though its effectiveness is well known; and therapy for long term personality problems is almost never covered by managed care. Managed care companies usually agree to cover treatment only to the extent that it focuses on symptoms. They usually refuse to cover treatment aimed at the underlying problems that cause symptoms. Managed care is a system that works best in dealing with crises. However, if people do not come to terms with the underlying issues, new crises are likely.

 (3) The Effects of Having a Psychiatric Diagnosis: Health insurance benefits can only be used for the treatment of illness. This means that your therapist must make a formal psychiatric diagnosis about you before the benefits will be available.  A psychiatric diagnosis can usually be made when people are in psychological distress, but many personal and life problems do not require a formal psychiatric diagnosis to be treated. We are increasingly seeing diagnoses come back to haunt people. Many people have found that using health insurance benefits for therapy has actually cost them money because, after making a claim, their premiums went up. This is despite overwhelming scientific evidence that therapy improves general health and reduces total medical bills. Life and disability insurance applications have been held up. Employers are sometimes notified about all medical care visits, including therapy, by the insurance company. The very existence of psychiatric diagnoses creates a false impression that most people sail through life without serious problems and only the ill need help. That is just not true. All of us, in our fast paced, highly stressful society, have hard times. None of us today can be expected to automatically have all the coping skills we need. Therapy helps people develop skills they have not yet had a chance to develop. The system of psychiatric diagnoses is only one way of looking at human problems. Its biggest advantage is that it helps get health insurance benefits, an advantage that is waning. Psychiatric diagnoses do not usually describe issues in ways that help people actually solve problems. In fact, diagnoses often get in the way. Other ways of looking at human problems are more helpful. Choosing not to use health insurance benefits means you do not have to have a psychiatric diagnosis. That means as people make decisions about you in the future, such a diagnosis will not be an issue  

I have had to write letters for clients who have applied for disability and life insurance. I have had clients denied for other health insurance due to psychiatric diagnoses. Also, I have had clients need letters when applying to take the bar exam to become attorneys. I have also had clients be denied for military service due to psychiatric diagnoses.

 If you do choose to use your health insurance, we will be glad to provide reasonable assistance.