I know that some people cannot afford therapy without aid from insurance, and I am very happy to work with my clients to help them get reimbursed by their PPO plan. I also want to give my clients, and anyone considering therapy, an overview of the pros and cons of going through insurance companies for reimbursements pertaining to mental health issues.
I understand that therapy can be expensive and that, for some, treatment without insurance reimbursement is not feasible. In this instance, I believe that seeking reimbursement through a PPO is a good option. Your mental health is valuable, and you should do what you can to insure you are getting the professional support you need. Some PPOs will reimburse up to 70%, allowing for people who could not otherwise afford therapy to get help. If the choice is between going through a PPO or not seeking therapy at all, than I believe the better option is to consult with your insurance about reimbursement. I hope that coverage for mental health will be more comprehensive in the future, and that legislation will continue to reform so that insurance companies can’t exclude people with pre-existing conditions from their policies. However, at this juncture, the downside of pursuing insurance coverage for mental health remains the potential financial consequence when seeking private insurance in the future.
In order to get reimbursements for their clients, a therapist is forced to provide vital and personal information about their the client’s mental state. As a result, “therapists…must justify…a patient’s need for treatment every 10 sessions.”(1) This means that a client’s progress is constantly under review by the insurance company. A therapist may need to answer questions about a clients symptoms and personal life. In my work, I like to emphasize a client’s strengths, and focus on how those can be utilized to address other areas in need of more help. The insurance company paperwork infringes on this perspective, switching the focus from what the client needs to what the health insurance companies want to hear. Ultimately, this means that in order to issue a reimbursement, an insurance company must hear from the therapist that a client has been diagnosed with a mental disorder.
Some of these diagnoses come with consequences: When you are applying for life/disability insurance or private health insurance in the future, a company will have access to any prior health information, including any diagnosis given during therapy. This can adversely effect your eligibility for acceptance into a plan, and can increase your premiums astronomically. The Catch-22 is, in essence, this: In order to continue to receive reimbursements, you have to continue to be diagnosed with a mental illness, but the diagnosis you receive could prevent you from getting health insurance in the future. Even if you do receive a diagnosis, there is no guarantee that coverage will continue.
I hope this article has been informative and that you feel like you can make a better decision about your situation, and whether or not you will seek reimbursement through a PPO provider. Your mental health is important and you should make it a priority to receive treatment in whatever way works best for you. Here are a few of the main points of this article to keep in mind:
•No therapist can guarantee that your insurance will reimburse you for services. This decision is made by someone at the company.
•If you plan to seek reimbursement, it is advised that you contact your insurance company prior to the first session and ask the following questions: – What percentage will be paid for services from an out-of-network provider? – What is my co-payment? – What is my deductible?
•Consider how receiving a mental disorder diagnosis will impact your insurance coverage and medical needs down the road.
•Being limited to choosing a therapist from an in-network provider can be very limiting and frustrating.
•Unless you have a parity diagnosis (The Federal Mental Health Parity Act allows someone with a qualified diagnosis unlimited sessions) you will probably only receive reimbursement for a limited number of sessions, generally an insufficient amount.
***Ethically, therapists can only give a parity diagnosis to people who meet the criteria according to the DSM-IV-TR. Even with a parity diagnosis, insurance companies may try to stop assisting you with receiving the help you need. In these situations visit www.mentalhealthparitywatch.org for help.
1 “Protect mental-health parity, but scrutiny is inevitable.” Boston Globe. 24 May. 2010: A10. eLibrary. Web. 14 Feb. 2011
2 Menaged, Samuel E. “Obstacles to accessing mental health care.” USA Today; New York. 01 Mar. 2003: 30. eLibrary. Web. 14 Feb. 2011.