Risks and Benefits of Using Insurance

You may want to use your insurance to cover the costs of counseling, or you may decide to pay out of pocket.  Since the best decision is an informed decision, below is important information about the risks and benefits of using insurance to cover costs of  your mental health care.

Benefits of Using Insurance:

You pay premiums for your insurance so it’s nice to be able to use it help defray the costs of counseling.  In addition, some insurances or HMO’s will cover a significant portion of counseling costs, saving you money.

Risks of Using Insurance:  

You will be diagnosed with a mental illness.

Before your insurance company will cover your counseling expenses, you must be diagnosed with a mental illness as listed in the Diagnostic and Statistical Manual (the DSM IV-R).  This means that even if you come to counseling with “life issues", you will leave diagnosed with a mental illness. 

Your diagnosis of mental illness will be put into your permanent medical record.

If you are involved in a court hearing, your medical records, including your mental health records, may be subpoenaed and could be used against you, for example, to deny child custody or placement.

In addition, if in the future, you apply for life, disability or health insurance your company will access your medical records, including your mental health records.  You may be turned down for coverage due to a prior mental health diagnosis or treatment.

Your personal information can not be guaranteed confidential.

When using your insurance, personal information you share with your counselor, including biographical information, diagnosis, etc. will be entered into the computer network of a clearing house or billing company.  It will then be forwarded to your insurance company’s computer network in order to pay for treatment.  In this internet age,  no computerized information can be considered completely confidential.  As a result, your personal information can not be guaranteed 100% confidential when using your insurance benefits to pay for counseling.

Your insurance company, not you, will be in charge of your counseling process. 

In order to receive the maximum number of covered visits per year, your insurance company needs to deem them "medically necessary".  That means your counselor may need to talk in detail to your insurance company about your issues and treatment in order for them to approve continued treatment. 

At times, additional sessions may not be approved unless you are willing to be assessed for medications, regardless of whether you or your counselor think they are necessary.  In addition, once your benefits are maxed out, you may be denied additional sessions, regardless of your progress in counseling, or your desire to continue counseling.