While I understand that there are perks for using insurance benefits to cover the cost of mental health counseling, there are also many drawbacks with accepting insurance coverage. I have weighed the pros and cons of accepting insurance (for both you as the client and myself as the clinician) and have decided, at this time, to not accept insurance.
Insurance companies mandate that a client be diagnosed with a mental illness (clinical diagnosis) to obtain treatment services. By not accepting insurance, we get to work together with or without an “official” mental health diagnosis. I mean, sometimes all that is needed is a little help to figure out a better way to deal with stress, obtain additional support, or problem solve, which insurance companies do not recognize.
Also, as a private pay client, your protected health information (PHI) remains confidential rather than being audited/reviewed by the insurance company (yes, they have the ability to access your diagnosis, progress notes, and other personal information).
Being a private pay provider allows me to offer more individualized and flexible sessions to you and enables me to provide you with a customized treatment plan tailored to your individual needs rather than a “cookie cutter” insurance-driven treatment plan. I have the ability to be more available for my clients (especially those who need multiple sessions per week) because I’m not spending extra time on submitting billing or completing other insurance paperwork. It also allows me to be more emotionally available because I haven’t spent my emotional energy having to explain to the insurance company why you DESERVE to receive appropriate mental health services without limitations.
In addition, I get to enjoy having the freedom and autonomy to utilize whatever treatment approach is most appropriate for each client, see clients without limits on sessions, and not be bound by insurance “rules.” Insurance limits the amount of time we get to spend together. Sometimes you may need more than a typical 50-55 minute session and now you have the freedom to enjoy such if YOU choose to do so!
In addition, seeking a therapist that accepts your insurance may require that you see someone who is less experienced or specialized.
However, just because I don’t accept insurance, that does not mean that you cannot utilize your insurance coverage for your services. I am considered an Out-Of-Network (OON) provider and there is the POTENTIAL for your insurance company to reimburse you for some or all of the cost of services. This varies between insurance plans; therefore, I encourage you to find out if your insurance plan will cover OON mental health services in an outpatient setting.
When speaking with your insurance company, you may also want to ask if there is a deductible, if there is a limit to the number of sessions that you can attend, and if pre-authorization is required. The typical CPT codes utilized for insurance are 90791, 90834, and 90837 (this specifies the type and length of session). Although I do not interact directly with insurance companies (I do provide you with a superbill that you can submit to your insurance company), using your insurance means that I will need to provide a clinical diagnosis and adhere to their standardized treatment plans, modalities, and you may have a limited number of sessions allowed.
Keep in mind that any time you use your insurance, the medical information disclosed becomes part of your permanent medical record. Therefore, the insurance company can still audit your file and have access to your medical/mental health information. In addition, having certain mental health diagnoses can interfere with your ability to obtain or can increase the cost of disability and/or life insurance coverage, limit certain employment options, and have other negative impacts. We can discuss this further if necessary.
