Why Counseling May Not Be Something You Want to Pay for with Health Insurance

Why not pay for counseling through your health insurance? Isn't that its intended use? To read the Future Generali Health Insurance Review, click here

Perhaps.

However, using health insurance for mental health services differs somewhat from using it for other medical problems. Your health insurance may occasionally exclude coverage for mental health issues. Once you have used your health insurance for mental health, a mental health diagnosis will be kept on file. It will pay for treatment only if a mental health disorder or mental illness is listed on the insurance claim. This will be recorded in your ongoing medical file.

Although it makes sense for you to consider using your health insurance to pay for counseling services, there are also some valid arguments against doing so.

Why is my counselor refusing to accept my health insurance?

For excellent reasons, many counselors opt not to accept health insurance. They want to devote all of their attention to caring for you. If they choose to buy health insurance, there is much more work involved than just deciding to work for a lower pay rate. The counselor may spend hours on the phone obtaining authorizations, benefits information, and claim payment updates. The insurance company's payment to the counselor is delayed by a month. The insurance provider must receive progress reports from the counselor. The counselor must provide the insurance provider with treatment summaries and other information regarding your medical background.

Although many counselors would prefer to devote all their time and attention to helping clients rather than filling out paperwork for insurance companies, it is not because they dislike insurance companies or don't want you to use your insurance (we have health insurance, too!).

However, this is only one of the reasons counselors might not be covered by your health insurance.

You should consider the other, stronger arguments before using your health insurance.

Many counselors choose not to participate in health insurance networks to better protect your confidentiality. Your personal, private, and emotional information is not kept in your counselor's office. It is not covered by their locked files or any information (claims, reports, or treatment plans) submitted to health insurance. Any insurance provider must deem you "ill" to reimburse or pay for counseling (both in and out-of-network). 

You must have a mental health disorder or illness identified by a diagnosis. Insurance will only cover counseling services if you are sick enough to merit a diagnosis. Your condition will be noted in your permanent medical record if you are diagnosed with mental health. Many therapists dislike the "medical model" of diagnosing someone as ill, so they decide not to accept insurance to focus on their client's strengths rather than assigning them a mental illness.

Do you desire to be categorized as mentally ill? First, find out your diagnosis if you already have a mental health diagnosis and have previously attended counseling or psychiatric appointments. This might not bother you if you've already received a mental health diagnosis, but if not, you might not want it in your medical file.

To maintain your privacy, counselors dislike sharing information with third parties. Who knows how many individuals review and approve a claim after it is submitted to the insurance provider as it moves through the system? In addition, the insurance provider can audit your entire file if they have paid for any counseling sessions (whether in-network or out-of-network). To determine whether you are actually "sick enough" to merit their payment, they may ask for copies of your counseling notes, evaluations, and other sensitive personal data. If they believe you are not seriously ill enough or that your counseling is not "medically necessary," they may refuse to provide you with services.

Additionally, many counseling-related issues aren't even at all covered by insurance. Typically, topics like stress management and anger management should be covered. Typically, marriage counseling is not covered. There may be an exclusion for some medical and mental health conditions. (such as attention deficit disorder or adjustment disorder). Even if your illness or disease is covered by your insurance plan, they may set a maximum amount they will pay per year or throughout your lifetime, as well as a cap on the number of visits they will cover (sometimes only 20 per year).

Counselors also prefer not to have an insurance company representative instruct them on how to care for their clients. Insurance companies have the authority to determine the types of counseling covered, the approved diagnoses, and the number of visits the client requires before they are cured. To best meet their client's needs, many counselors prefer to work directly with them without interference from an insurance company.

Your security clearance, life insurance rate, employment, or future health insurance coverage may all be impacted by using your health insurance to pay for counseling services.

Please educate yourself on using health insurance for counseling for the above reasons. Regardless of your decision, exercise informed purchasing.

Be a savvy consumer.

Know the diagnosis of your mental illness.

Examine the diagnosis with your therapist.

Discuss your treatment reports with your counselor.

Determine whether you have or want to have a mental illness.

If you experience clinical, severe anxiety, depression, or other problems, you most likely already have a diagnosis.

However, your symptoms may be minor if you're stressed, having relationship issues, or trying to figure out your purpose in life, and you might not want a mental health diagnosis on file.

Your diagnosis becomes a permanent part of your medical record once an insurance claim is submitted to your health insurance provider. This means that it may impact future life insurance, preexisting conditions, or the price of private health insurance.

In Manassas, Virginia, Jama Thurman holds a license as a professional counselor. She assists stressed-out and anxious adults and teenagers in finding meaning and peace.