How I use insurance and why
How I utilize insurance at my practice
A detailed receipt of all payment and services called a “superbill” will be sent to you digitally via email every month. The superbill is designed for you to request insurance reimbursement from the insurer. Once you send the insurer the superbill, a determination is made by your insurance company about reimbursement and how benefits will be applied. As an out-of-network provider, you can check with your provider to see what their out-of-network benefits are for counseling and couples counseling services. Contact the number on the back of your insurance card to request this information. Be sure to specify what kind of services you are requesting because many providers will not cover couples counseling. If you’re checking with insurance, here are billing codes to ask about: 90791- 60 minute diagnostic assessment, 90847- 60 minute couples therapy session, 90837- 60 minute individual therapy session.
Risks to consider before using insurance for mental healthcare
It would seem obvious to use your health insurance to pay for mental health services. But there are actually some risks to be considered.
Therapists who are in network providers are required to share confidential treatment information as well as diagnoses with insurance companies. This makes maintaining your privacy and confidentiality difficult or even impossible.
Insurance companies only pay out for what they determine to be “medically necessary.” It isn’t uncommon for a therapist to give a more severe and incorrect mental health diagnosis simply to obtain reimbursement from an insurance provider. There are times that clients are unaware of the severe diagnosis they are carrying and its potential impact.
Any diagnoses or treatment information sent to an insurance company will go on your permanent health record. This could have future implications such as hindering job opportunities, diagnostic or treatment information coming out in a lawsuit, and potentially limiting future insurance coverage.
When insurance is used for mental healthcare, insurance is also in charge of defining treatment. Depending on the diagnosis, insurance providers will stipulate what kinds of services and the length of treatment they will pay for. For in-network therapy services, the entire experience is dictated by the insurance company not by your unique situation or needs.
Health insurance companies follow an illness model of care like you would have when you go to the doctor for the flu. Only when someone is “sick” do they get insurance reimbursement. Although this makes sense at your doctor’s office, it’s unclear how the same logic would translate in therapy. The problem with this concept is that people want to be mentally and emotionally well and healthy and don’t want to wait until they experience a crisis to receive treatment. Many clients wish to prevent crises and promote growth in their relationships. However, those goals would be deemed “medically unnecessary” by an insurance provider. For those who are hoping to use their health insurance this way, you are left with a few options: wait until the problem is severe enough to meet full criteria for a mental disorder or illness, or have your therapist use an incorrect and more severe diagnosis to gain access to insurance benefits.
Because insurance companies hold to an illness model of treatment, they are promoting the stigmatizing beliefs and ideas that prevent people from accessing mental health treatment. If counseling is only deemed necessary for those who are mentally disordered or ill, then it communicates ‘those receiving mental healthcare are damaged, weak, sick, and not healthy.’
Because it is important to me to fight against the stigma of receiving mental health services, to advocate for the use of a wellness model of healthcare, to protect your privacy and confidentiality, and to allow you to have the freedom to be in charge of the services and treatment you receive, I choose not to be an in-network provider.
