Please read carefully! This is to alert you to some of the possible consequences of using your insurance. Health insurance companies limit coverage to only services that are a “medical necessity”. In order for the insurance companies to see the counseling/psychotherapy as a “medical necessity”, a mental health diagnosis is required. The reference book for diagnosis guidelines is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. More commonly referred to as the DSM-5. This manual describes the symptoms of emotional and mental illness. If the symptoms that you are experiencing are consistent with those of the DSM-5, psychological services should be covered by your insurance company.
There are some “dis-eases” that all of us experience that require counseling help, but do not meet the criteria of a “medical necessity”. For instance, if you are having ongoing marital conflict, this may require professional help but it is generally not covered by insurance. If someone is in need of career counseling, it is important to seek professional input, but career counseling is not a service covered by insurance companies. Others may feel that they are not living up to their full potential and want to experience “personal growth” in order to feel more fulfilled with life. Although all of these examples are excellent reasons to seek professional counseling, they do not meet the “medical necessity” prerequisite required by the insurance company. Therefore, insurance generally will not cover those expenses.
As professional counselors, we strive to provide a safe place where you feel more free to be honest and open, where all your very personal information is kept confidential. We believe the idea of confidentiality is crucial to a trusting and healing relationship. This confidentiality is waived, to some extent, when you use your insurance. That is, insurance companies require information that will confirm that there is a “medical necessity” and the appropriate counseling services are being provided. This means that your insurance company may require a review of your clinical records. When applying for your insurance, you signed a release for your medical/counseling records.
Therefore, personal information shared during your sessions is subject to release to your insurance company upon their request. Rarely does the insurance company request this information; however, it does happen and we want you to be aware of the possibility. Also, your insurance company may maintain a direct involvement in reviewing your progress and managing the number of sessions which you will be allotted, regardless of the total sessions your policy offers. Also, some managed care companies request that the mental health provider coordinate health care with your primary care doctor.
It is also important to know that in the future other types of insurance coverage might be adversely affected by the use of your insurance for mental health services. There have been cases where companies have charged higher premiums. In some families they were turned down when they applied for disability and life insurance due to mental health diagnosis. Another fairly standard policy is to have a waiting period for pre-existing conditions if you change insurance companies.
Some of our clients have been unhappy with the insurance companies’ intrusion into the client/therapist relationship. When taking all these factors in to consideration, in some cases it may be less expensive in the long-run to pay out of pocket. The same services can be provided without a diagnosis of a mental health disorder. In spite of these concerns, we are committed to maintaining confidentiality to the fullest extent that we are allowed. Please carefully consider whether or not to use you insurance benefits.
Our Standard Fees are: $130 Initial Intake Session (45-60 min), $110 Individual Session (45 min), $125 Family or Couple's Session (45 Min), Extended Session (60 Min) 145.00
We appreciate you taking the time to read all this “fine print”. Our desire is to give you as much information regarding the use of your health insurance for mental health counseling as possible. If you have any questions, please discuss them with your counselor.