Insurance Coverage

This is a tricky topic to cover but I think very important. I want my clients to understand the way this system works and to be good advocates for their health and care. While I do take some insurance to diversify my caseload I would like my clients to be aware of the requirements and possible issues with using your health insurance. I will list a few below. Please feel free to ask any questions.

First all insurance companies require a diagnosis of a mental health condition.

Insurance companies only pay for things that are “medically necessary.” This means that someone has to actually diagnose you with a mental health disorder AND prove that it is impacting your health on a day-to-day basis. Many of life’s problems are not mental health disorders. Many people seek treatment before their issue would meet criteria for diagnosis as a mental health disorder, which is such a good thing.

Understanding What a Diagnosis Means

If you get diagnosed with something, you should be able to decide who gets access to that info and why. You lose control of that information when it is in your file being faxed to anyone in the health care industry who ever requires access to it. A diagnosis says nothing about how you cope, what your strengths are, and which of the many symptoms you actually have. But a diagnosis will speak for you and may negatively impact you.

Loss of Confidentiality = Loss of Control Over Who Gets Your Information and What They Use It For

Anything that is part of your file becomes a permanent part of your file. This means that when you apply for new health insurance, life insurance, and many types of job, they can require an authorization to release information to view your entire medical record. With health care reform, being denied coverage due to a preexisting condition is thankfully less of an issue, however, companies can charge much higher premiums because of having ever been treated for a mental health issue.

A diagnosis is not the only thing that becomes part of your file. Insurance companies require treatment plans, progress reports, and many other types of personal information to determine what, if anything, they will cover. These details about your treatment should be private, but instead they are open and available to anyone with access. This could include potential employers. The average insurance claim passes through 14 people while it is being processed.

Having coverage doesn’t mean you are covered.

The insurance company has several processes to approve treatment. They often only approve a certain number of sessions, even if more are necessary. They will often deny your claim and it could take months to get reimbursement, if at all. This can interrupt treatment.

It should be between you and your therapist to determine what comes next in your treatment and how much of it you need. But, imagine an insurance agent sitting next to you in your session, clipboard in hand, making decisions about whether you truly “need” this therapy or not.

If you decide to use insurance (directly or by reimbursement) please make sure to contact them before treatment begins and get approved.  Ask what information you will need to present for reimbursement.

It All Boils Down to Choice

Many insurance companies do not give you a choice of what therapist you can see. They have preferred providers and you must choose one of them.  Even if you are happy with your provider, as I said, you don’t have a choice about what information is put into your file and shared with everyone. You don’t get to take that information out of your file once it is there. This can be devastating for some, and a minor irritation to others. You are the only person who can decide what is right for you.

You have a choice in who you see, whether you see them for a long or short amount of time, and whether you’d rather use your insurance. We just want you to have all of the info you need to make the right decisions for your health and your family.

What Else Can I Do?

See if your insurance will reimburse you for out of network providers

I would be happy to provide you with statements/invoices that many insurance companies require. And if you are denied coverage, we can fill out the necessary forms that they require the provider to complete for the appeals process.

This puts you in charge of your information and it’s release.

If you are contacting your provider to see about coverage for out of network providers, ask the following:

  • How many sessions are covered?
  • Do I have to meet my deductible first? Is there an out of pocket max?
  • Do they require a treatment plan or detailed summary for reimbursement?
  • Do they reimburse for VCodes?
  • What are the qualifications required of the practitioner? What information do they need from the therapist?

Use Pre-Tax Dollars

I do take all types of HSA and FSA cards with major credit logos on them. If you do not have one of these accounts, you could speak with your tax preparer to see if you could deduct therapy expenses from your taxes as an out-of-pocket health expense.

Seek Lower Cost Therapy

There are several wonderful clinics in the Jacksonville Area that provide low cost therapy. Two great options are:

NorthWest Behavioral Services

Mental Health Resource Center

Here are some additional articles covering this topic as well

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