Using Insurance for Therapy
Have you ever been put off trying to find a therapist because no one takes your insurance? Or continued working with a therapist who maybe wasn’t quite the right fit, but they were the only one who took your insurance and it felt like it was better than nothing? Looking for a therapist, and finding the right fit, can be a difficult process. It can be especially difficult if your options are limited to therapists that are in-network with your insurance company. In this post, we’ll take a look at why it is worth considering working with a therapist who doesn’t take insurance.
What Happens When You Use Insurance for Therapy?
Before talking about why you might want to work with a therapist that doesn’t take insurance, it’s important to understand what happens when you use insurance for therapy. First, most insurance companies only pay for therapy sessions if they are deemed “medically necessary.” In order to be considered medically necessary, you must be diagnosed with a mental illness. Furthermore, you must be diagnosed with a mental illness that your insurance company will cover the treatment costs for. Not all insurance companies cover all of the mental illness diagnoses that are listed in the DSM-5, the diagnostic manual used by mental health professionals.
The requirement of a diagnosis has two consequences. First, the diagnosis you are given determines the number of sessions and the type of treatment that your insurance will cover. This can vary widely between insurance companies and diagnoses. Second, that diagnosis becomes a part of your permanent health record. Moving forward, it will be considered a pre-existing condition, which may affect future insurance coverage or cost.
The second major factor to think about when considering using insurance for therapy is that your records are no longer confidential. The insurance company can access your records, which contain your therapist’s notes on each session. Many people share some of the most intimate, private information about themselves in therapy because they trust the therapist they’re sharing with. But what many people don’t realize is that when you use insurance, employees at the insurance company then also have access to any of the information that your therapist has recorded in their notes.
Having Insurance Doesn’t Guarantee Coverage
One of the main issues with only considering therapists who take your insurance ties back to the fact that insurance companies require a diagnosis to even consider paying for your sessions. Many people who seek out therapy do not have a mental health disorder. They go to therapy to help them through grief, relationship issues, stress, or a particularly challenging situation. In those cases, the client is unlikely to be given a diagnosis. In order to receive a diagnosis for a mental health disorder, you must meet a set of criteria that are laid out in the DSM-5. And while many people experience symptoms of mental health disorders, they don’t always meet the criteria for a diagnosis. Therapists can’t just give you a diagnosis to make sure that your insurance will cover your sessions- that would be insurance fraud.
It is not uncommon for clients to begin therapy thinking that their insurance will pay for the sessions, only later to realize that they don’t meet the criteria for diagnosis and must pay the fees themselves. It also is not uncommon for clients who do receive a diagnosis to still be denied coverage. Many insurance companies note that “A quote for benefit does not guarantee payments.” Even if you receive a diagnosis, your insurance company may review it and deny you coverage, leaving you on the hook for fees you weren’t expecting to pay.
The last thing to consider when limiting your search for a therapist to only those in-network with your insurance company is whether or not you’ve met your deductible. If you haven’t, you are likely still responsible for 100% of the fee until the deductible is met. Once met, you are then responsible for your copay. Depending on how high your deductible is, you might not meet it before your treatment is over. In that case, you may seriously want to consider whether the benefits of using your insurance outweigh the potential downsides listed above.
Pros and Cons of an OON Therapist
Many therapists are “OON” (out of network), meaning they are not on your insurance company’s panel of providers. They accept “out of pocket” payments, sometimes called “fee for service” or “private pay.” In these cases, you pay your therapist directly and none of your information is shared with your insurance company. In addition to widening the number of therapists you could potentially work with, (thus increasing the likelihood of finding a good fit!), other benefits are that your sessions remain truly confidential, you are able to choose a treatment modality that best suits your needs and preferences, and no pre-existing conditions are added to your permanent health record.
Provided your specific insurance plan covers the mental health services you need and you have met your deductible, the downside to working with an out of network therapist is that you bear the full cost of your sessions. This simply isn’t financially feasible for everyone. Don’t be discouraged if you find a therapist online that you think would be a great fit for you but you can’t afford their full fee. Reach out to them anyways and ask if they have any reduced fee slots or offer sliding scale fees. Many therapists do, and will work with you to find a fee that is acceptable to both of you.
Ultimately, there are pros and cons to using your insurance for therapy, just as there are for paying out of pocket. The most important thing is to be informed about the benefits and any potential downsides so that you can make an informed decision. For most people, the priority is getting the help they need when they need it. By expanding your search to include out of network therapists, you increase the chance of finding the right therapist for you more quickly. Whether you choose to use your insurance coverage or pay out of pocket, the important thing is to get the help you need.
_____________
If you’re interested in working with me and would benefit from a reduced fee, please don’t hesitate to reach out.
