Medical Insurance for Mental Health Services?
The Advantages and Disadvantages

What Should You Know Before Choosing to Use Your Medical Insurance for Counseling?

Medical insurance is expensive! And who wouldn't like to feel they're getting some benefits from paying those expensive premiums each month? But there are some things you should consider before deciding whether or not to use your benefits for counseling.

As you might imagine, this is a touchy subject for many reasons.

Remember that medical insurance companies are, and always have been, a for-profit business and that means they need to make a lot of money to satisfy their stockholders and stay in business. And they make that money by paying out less in benefits than they take in with premiums.

What is Mental Health Parity?

You may have heard about the passage of Mental Health Parity legislation that went into effect in 2010. This legislation was intended to help people have the same level of access to mental health professionals that they have to medical doctors.

It was supposed to mean that insurance companies would no longer be allowed to limit the number of times you could see your counselor, just like they can't limit the number of times you see your family physician.

The reality has worked out somewhat differently.

If the new law meant insurers were no longer able to limit out-patient counseling to 10-20 sessions per year, they had to devise another way to keep some control over making benefit payments, or risk the consequences to their bottom line.

Your Privacy is at Risk

One of the ways major medical insurance and managed care companies are trying to keep some control over access to benefits is through the use of Behavioral Health Teams (BHT). BHTs are people hired by the company to grant or deny requests for additional counseling after the first set of sessions have been used.

In order to make that decision, most BHTs require therapists to complete an Additional Services Request form and submit it with supporting documentation, specifically your intake assessment, treatment plan, approach to therapy, progress notes, prognosis, and expected frequency and duration of treatment.

These teams may or may not be trained as I am about different treatment methods, yet they have the power to decide how I can work with you or they won’t cover your sessions.

You should know that insurance contracts that you sign and that providers sign include the right of the company to review your charts. They frequently hire a 3rd party contractor to do these reviews; and although they agree to maintain confidentiality, these organizations may not be trained to the same ethical standards that mental health professionals use.

You should also know that virtually ALL medical plans specifically exclude marital counseling, family counseling, bereavement, sex or interpersonal relationship counseling, to name a few.

Keep in mind that medical insurance only provides payment for services that are deemed medically necessary. That means that they base coverage on whether or not you, as the identified patient, fit into a medical model that labels you with a pathological (i.e. medical) mental illness.

So...the answer to the question: Will Insurance Cover Consulting Services? is a resounding No!

I’ve even seen some plans that refuse to provide any benefit coverage at all unless you see an in-network provider. So the only therapists that you can see are those willing to abide by their rules.

Confidentiality Compromised

Sometimes the company will restrict parity to a handful of diagnoses, and disallow on-going services for others. For example, Adjustment Disorders are a type of mood disorder that people experience as a result of struggling to adjust to major changes in life. By definition, Adjustment Disorders are temporary, subsiding when the stressor is resolved.

But some diagnoses are considered permanent, in that they become part of your insurance permanent medical record. Insurers share and use this information to determine whether you fall into a high-risk pool and, therefore, can be charged a much higher premium.

This permanent record is part of a national database that other insurers can access, too, in case you try to change insurance companies in the future.

Even scarier to think about is that we have all learned to our sorrow that anything on-line should be considered non-confidential. If hackers can get into top governmental databases like the Department of Defense, is there any doubt about their ability to hack into company databases?

This means that all our individual and collective efforts to ensure privacy on-line are unable to absolutely guarantee the safety of our personal information. We’ve all heard about identity theft as well as human error (accidental as well as intentional) that results in personal information falling into the wrong hands. Would you want an employer or a potential employer to gain access to your information? What about a life insurance salesman?

What Other Choice is There?

I'm glad you asked!!

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Brought to you by:

A Better Day Counseling Services & Paula Sharp, LCSW

Serving Boise, Eagle, Meridian and Treasure Valley, Idaho

Located at: 1414 W. Franklin St., Boise, ID 83702

(208) 344-4343

In the Heart of Boise, for Good!

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