“Do you take my insurance?”
This is often the first question we get asked when someone calls or emails for more information on our services. Let me start off by saying that yes, we do take some insurances and we are willing to work with insurance companies that we are not contracted with (where we are considered out of network). We understand that when the “Affordable Care Act” went into effect, it has caused more people to have insurance but also made insurance less affordable for others, increasing the need to utilize the benefits that you are paying for. We can certainly respect this, and that is why we do still work with insurance. There are some real and big concerns with using these benefits, however, that even I didn’t know until I started accepting insurance in my practice. I would like to share these concerns with you so you can make an informed decision about whether you would like to bill insurance for your treatment or not.
The first concern we have with insurance is that it limits the confidentiality with the client. Confidentiality in counseling not only covers what you say but also your diagnosis and the fact that you are even in counseling. For an insurance company to pay for your treatment, however, they obviously have to know that you are a client receiving treatment. Insurance companies will only cover services that are deemed “medically necessary”. In order for us to “prove” that your sessions are medically necessary we have to provide a diagnosis that goes to the insurance company. This means that they not only know that you have been seen, but also for what problem. Now, it is a large corporation and many of us will never know the people who see the claims and therefore are not bothered by this, but it is important to acknowledge that we don’t know just how many people will indeed see it.
In addition to claims which only include your name, date you were seen, diagnosis, and type of service provided, insurance companies can audit a clinician’s records. As part of the contract that clinicians sign with the insurance company (and that clients sign with the insurance company), we have to allow the company access to our records at any point that they want. These records include more personal information including your treatment goals, your symptoms, what was discussed in the session, and your progress. Again, you likely won’t know the person doing the audit (the one time I had a case audited the auditor was in another state and it was done via phone) but this is still your personal information that is being shared with another person that was not intended to hear it.
Permanent Records & Insurance
Every diagnosis you are given, whether mental health or medical, is part of your medical record. Each provider keeps their own medical records. As soon as an insurance company is billed for a service, it also becomes part of the medical records the insurance company keeps. There is a company called MIB which the majority of insurance companies belong to. It is an information sharing group so your insurance company shares the information about you with them, and then any other insurance company you may be trying to obtain insurance from can then obtain your records from MIB. How might this affect you? If you try to obtain an individual health insurance plan or even life insurance or disability insurance, the company you are trying to get a policy with will likely check MIB to see what you have been diagnosed with. These diagnosis give them information about their risk of insuring you. Depending on the diagnosis (or even combination of diagnoses) and type of insurance you may get an outright denial, or more likely you may not be eligible for the premium rates and therefore have to pay a higher rate for your insurance.
Insurance Dictates Treatment
When insurance is paying your bill for treatment, whether the therapist is in-network or out-of-network with your insurance company, the insurance company has a say about the treatment you receive. Imagine that you are getting married but do not have enough money to pay for a reception and a third party, like your mother-in-law, offers to pay for it. At first you may be very excited since this means that you can have something you wouldn’t be able to afford on your own. As time goes on though, she becomes more opinionated on how her money is spent, dictating the colors, the flowers, and even the vendors used. You have different ideas of what you want the event to look and feel like as well as who you want to work with to achieve these goals. But she has a vested interest and wants to feel like she got her money’s worth as well. This can be what it is like to work with the insurance companies. They dictate who you can work with and how that provider can help you reach your goals.
In addition to what types of therapy they will cover, they limit the providers they will cover services with. It has nothing to do with the effectiveness of the provider or any other attribute of the provider. Once insurance panels reach a predetermined number, the companies “close” them, not allowing any other providers to join and be in-network with the company. The only reason I have been given for this is due to cost containment. Along the same lines, they dictate that they will only cover certain techniques to be used in therapy. For instance, I use hypnosis in my counseling practice because it is an effective tool to help make changes on the subconscious level since we act from our subconscious associations and beliefs 95% of the time. Many of the insurance companies don’t cover hypnotherapy.
Many of these drawbacks to insurance are completely understandable from the insurance companies point-of-view. They are a business and have to have a way to conduct their business so they are profitable and can stay in business. They look for ways to contain costs which may or may not effect the treatment you receive. Many people are able to use their insurance benefits without any noticeable negative effect and are thrilled that it provides them the opportunity to receive services they likely would not be able to afford otherwise. As part of our business, however, we ethically have to inform our clients of the drawbacks. If you understand these and still feel comfortable using your benefits or feel that it is necessary we will be more than happy to help you utilize them! You can give us a call to find out which insurance plans we are able to accept and/or for help in finding out your out of network benefits.