StaffUsing Health Insurance for Psychotherapy Claims
Many psychotherapy clients of Andrews & Associates choose to pay privately for their therapy sessions rather than access their health insurance for reimbursement. The nature of health insurance companies and policies can create future difficulties for those using their insurance coverage for mental health issues. In the past these problems have not received a tremendous amount of attention by therapists and their clients. However, Andrews & Associates understands that many consumers are becoming better informed about these issues and that clients want to know how the use of health insurance can affect their future.
To help clients afford mental health care while avoiding problems with insurance, Andrews & Associates has developed a program that keeps costs down and maintains the highest possible level of client confidentiality. Here are some questions and answers about mental health and health insurance that will help you get a sense of the problem.
Why not use insurance to pay for mental health claims?
Generally, when a mental health professional files a claim for payment with a client’s health insurer, the company requires the professional to state a specific mental disorder for which the client is being treated. Studies show that visits to a mental health professional are often for issues related to relationships within the family, at work, or with others. However, while these issues are extremely important to clients, they do not qualify under most insurance policies as deserving of coverage. So, if the insurance claim is to be accepted, the mental health professional must report a diagnosis of a reimburseable mental disorder, if it exists. While "reimburseable mental disorders" frequently occur alongside relationship issues, it is the mental disorder that gets the attention of the insurer.
Why does it matter to a client if the mental health professional reports a more serious mental disorder diagnosis?
In many cases it may not matter at all. But there are an increasing number of cases where clients who have had these diagnoses placed on their permanent health record finding it more difficult later to get health or life insurance because of their past diagnosis.
It doesn’t seem fair that an insurance company would deny coverage to someone who sought the help of a mental health professional in the past.
The fact is that there is currently a lot of work being done at both the national and the state level to help bring mental health insurance coverage into line with physical health insurance coverage. But, meanwhile, third-party payers may fear that coverage for mental health will cut into their ability to provide payments for the treatment of physical illnesses and that they must do what they can to limit payments for therapy. On the other hand, studies show that many of the visits to a physician are for issues more related to mental health than physical health and that easier access to psychotherapy services can actually reduce the cost of health care. Someday in the future you may be able to access the services of a mental health professional as easily as those of your family doctor.
Well, except for the diagnosis issue, are there any other reasons to avoid filing insurance claims through the office?
Perhaps the most important issue to many clients is the lack of privacy they sense when their therapy records are open to their insurance company. While the old-fashioned stigma of visiting a mental health professional has largely disappeared, most people do not want others having access to their therapy files. Therapy is, typically, a private, personal process and confidentiality is a concern of all professionals. However, to maintain tighter control on mental health expenditures, third-party payers may insist on having full access to client records.
What if I can’t afford to pay for my therapy myself?
Most insurance policies pay only a portion of the cost of therapy in the first place. If you take a close look at what you’ll pay by using your insurance and what you’ll pay without it, you might be surprised. Plus, there is likely to be some motivation to accomplish your therapy goals in fewer sessions when you "self-pay" rather than using your insurance, which could save you more money. You may also have a flexible benefits/cafeteria plan available to reimburse yourself for the costs of therapy.
Our goal is to provide our clients with the highest quality of professional service with the highest possible level of confidentiality. We want your main concern to be working on the issues that bring you to therapy, not worrying about your privacy.
How can "private pay" keep my costs down?
Andrews & Associates offers a deep discount for clients who pay for their services at the time of treatment. So, if you pay when you come to the office for your therapy session, you'll receive a discount over the regular charge for therapy. This discount is available to you regardless of your choice about using health insurance. The only requirement is that the charges for your visit are paid at the time of service. You might find that paying at the time of service makes your costs similar to using insurance and paying your co-pay.