Due to the COVID-19 pandemic we are currently welcoming clients in person and virtually.

Pros and Cons of Using Insurance for Therapy

Pros:

The cost

  • You already pay for your insurance with monthly premiums so it only seems fair that you should use us. By using insurance a portion or all of your session may be covered making your out of pocket expense smaller.

Cons:

Insurance requires a mental health diagnosis:

  • Insurance companies only pay for what is considered “medical necessity”. This is a term used by insurance companies to describe a treatment or procedure that they believe must occur. Part of the goal of insurance companies is to cut costs, one way that they do this is by covering services that they deem necessary.

  • For you to be able to utilize your insurance the therapist MUST provide the insurance company with a mental health diagnosis that you qualify for. This diagnosis goes into your permanent medical record.

  • Often times couples seeking therapy are doing so to improve their relationship not because something is medically wrong. However, In order to use insurance one member of the couple has to receive a diagnosis.

  • While your insurance company may tell you that they cover couples or family therapy they only do so if one of the people being seen is given a diagnosis. Essentially, one of you is seeking treatment to address this diagnosis and your partner can be in the room with your. The focus of the therapy should be on addressing the disorder.

  • While for some people this is not an issue at all, some high-level professionals can face unexpected consequences if they have a documented psychiatric diagnosis on their medical record.

Give up some confidentiality:

  • When a bill is submitted to the insurance company, employees of the insurance company gain access to your information in order to process the claim.

  • Once a diagnosis is entered it becomes part of your permanent record. This can impact you if you apply for life insurance or disability insurance. Some job applications will also require you to disclose any diagnosis or ask to review the information.

  • Insurance companies sometimes request information as part of an audit and the therapist is required to submit it. This information can include, but is not limited to evaluation, treatment plan, diagnosis, session notes, session dates and times.

Surprise costs:

  • Insurance companies all say ” a quote of benefits does not guarantee payment” Each person’s benefits are subject to the their specific contract restrictions. This means that even if you have found someone in network, insurance may not cover them due to your contract exclusions.

  • Some insurance contracts will exclude certain licenses such as an LMFT.

  • Being told verbally over the phone by your insurance company doesn’t guarantee that it will be covered once the specific claim is actually reviewed. If a claim is denied the client is responsible for the fee of the service.

  • You may have a deductible that needs to be met before the insurance company will cover some of the session.