What’s the deal with insurance?
For many people, insurance coverage has increased access to mental healthcare. This is a great step in removing barriers for therapy. However, there are a few things to consider when using insurance:
Using insurance requires a diagnosis.
Insurance bases mental health coverage off of a diagnosis meeting International Classification of Diseases (ICD) criteria. ICD is an organizational system to classify symptoms and diagnoses maintained by the World Health Organization. Receiving a diagnosis can be incredibly affirming to some people, and feel limiting to others. For example, in some high demand jobs, such as the military or government positions, your records could be assessed. As a reminder, it is illegal for employers to discriminate for a mental health condition. For others, a diagnosis may not be appropriate because you may be seeking therapy due to just experiencing life as a human. This pathologizes a normal response to a stressful event. Having a hard time is not a sickness; it’s human. Therapists are trained to assess for diagnostic criteria and can help clients understand if they meet criteria for a diagnosis.
Clients must meet medical necessity.
Insurance requires that individuals meet something called “medical necessity”. Medical necessity means that clients are experiencing symptoms at an intensity that causes functional impairment, meaning they have trouble either in day to day living, work, or relationships. It should be known that we all have symptoms of mental health conditions at any time in our life that don’t necessarily cause functional impairments. Therapists are trained to identify functional impairments that support a need for psychotherapy intervention through assessments and interview questions. If using insurance, it is important to share all information to inform an accurate assessment of functional impairment. This is not the time to put on a brave face - let the therapist know what is really going on with you.
Insurance companies can request medical records.
Insurance companies can request your medical records to verify claims. Please know that this is extremely nuanced as to what they can request, and therapists will take proper legal and ethical steps to protect mental health information. Opening up about what brought us to therapy is difficult and requires a huge amount of trust that our information is confidential. Therapists take this trust very seriously.
Insurance coverage may dictate treatment.
Insurance coverage may determine which provider can be seen (based on whether a provider is in or out of network), how many sessions available (some plans have limited number of sessions), and what kind of treatment clients can receive (evidence-based therapies are widely covered; experimental therapies may not be covered). This is something to consider when determining the best mental health option and provider for you.
What if I decide these are drawbacks to my goals for therapy? What are my options?
Choose not to use insurance.
Most therapists will take payment via major credit cards, HSA, FSA, and card processing services like Zelle, Venmo, etc. There are the few that continue to accept cash or check. If you find that the fees may be unaffordable, some therapists will offer sliding scale fees, discounted rates due to financial hardships, pro bono sessions through volunteer organizations, or offer payment plans.
Join a therapy group.
Therapists are able to offer group therapy services at a lower rate per session. Much of the information can be very beneficial, and some therapies are more effective in a group setting. While it might not be individualized care, the skills and education available are invaluable and can drastically reduce distress. Just knowing that other people have been through similar circumstances can increase human connection, a very good anecdote to depression and anxiety.
Seek out therapist-created courses, podcasts, or other mediums for mental healthcare.
Therapists are turning to alternative approaches such as podcasts, social media, and courses for purchase to reach a broad audience. Therapists want mental health knowledge to be widely and easily accessible to you. This information is being presented in digestible tidbits to incorporate into your life at low or no cost.
Ultimately, the decision to use insurance is a nuanced one. As the owner of Inclusive Reproductive Healing, I have chosen to accept certain insurance plans because I do believe in accessibility and affordability of mental healthcare. I personally have used insurance for my own mental healthcare. It’s essential to have all the information to make the best choice for you.
