Insurance Issues In Psychological Treatment - How to Pay

 

The Choice Between Using Insurance or Paying Privately

There are benefits and risks to the use of health insurance. The clear advantage is that insurance coverage may reduce your expenses. However, we find that increasingly more of our clients see disadvantages to use of their insurance and prefer to pay for their sessions “out of pocket,” seeing this expense as an investment in their future and their healthier, more meaningful lives. If you choose to pay for your sessions privately, we can provide you a year-end summary of your expenses for your use in tax preparation.

Disadvantages to the use of insurance benefits include the following:

Managed health care plans such as HMO’s and PPO’s may require authorization before they provide reimbursement for mental health services. These plans are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While much can be accomplished in short-term therapy, some clients find that they desire more services after their insurance benefits end. Some managed-care plans forbid us from providing services to you once your benefits end.

All insurers require that a clinical diagnosis be provided on the claim they process. Sometimes they require that we provide additional clinical information such as treatment plans or summaries or even copies of your clinical record. This information will become part of the insurance company files and will probably be stored in a computer or larger database. In some cases, they may share the information with a national health information data bank. Although all insurance companies claim to keep such information confidential, we do not have control over what they do with your information once it is in their hands. In the case of a child or teen, a clinical diagnosis may follow him or her throughout a lifetime.

Unfortunately, clients sometimes find that because of previous mental health diagnoses, they are unable to get health or life insurance coverage in the future. Insurance companies routinely check with the medical information data banks when evaluating an applicant. Even if you don’t tell a new insurance company about previous treatment, they may discover it in processing your application.

Some employers check health/insurance records without the employee’s knowledge before making promotion decisions. If the employer is enlightened in their attitudes about psychotherapy, they may know that it is a useful tool to help employees become healthier and happier in their lives. However, we cannot guarantee how any employer may regard this information.

Finally, recent federal rules under the Patient Protection and Affordable Care Act may require insurance companies to send health information to Washington’s Department of Health and Human Services.

If you are considering not using insurance to pay for services, please contact us for possible financial arrangements.