What you don't know about insurance and therapy
Perhaps you have done your research, and you’re ready to begin therapy. There are lots of decisions to make: What therapist to choose, when to begin therapy, what questions to ask the therapist, what to focus on in therapy and whether or not to use your insurance. It’s a tough call. But before you make the decision, let’s talk a bit about the insurance piece.
Here are 6 things you should know before you make the decision about whether or not to use your health insurance when you go to therapy. Of course for many, it’s a no brainer. After all, why would you want to pay for health insurance each month and opt not to use it when you’re seeking therapy services?
Now, before I begin, let me make it clear that I am not for or against insurance. It’s important that you make an informed decision and that you do what is right for your specific situation.
Okay, here it goes:
1) Your insurance doesn’t always pay your therapist’s full fee
Typically, when you go to a therapist’s website in the Murrieta/Temecula area, you might see a tab on the site that says “Insurance and fees” or “Rates.” It’s important to note that many insurance companies do not actually pay your therapist their full fee. Some reimburse very poorly, and others are more generous. Sometimes you’ll have to pay a co-pay in order to see your therapist. Other times you’ll be responsible for the difference. So for example, if your therapist, psychologist or counselor charges $100 per session, and insurance only reimburses the therapist $85, you’ll be responsible to pay the leftover bill of $15.
It’s important to call your insurance company before beginning therapy or counseling services in Murrieta/Temecula so that you are able to budget appropriately. So for example, let’s say your therapist’s full fee is $100 per session, the insurance company makes a judgment call about how much to pay the therapist. Many times it’s not based on your therapist’s educational background, training and experience. There is typically an arbitrary ‘Usual and customary rate.’ The insurance company can choose to reimburse the therapist as little as $30 for a session or if they are generous, they might pay the therapist more. They decide the therapist’s worth.
2) Your information is not always confidential
When you use your health insurance, ask the insurance company exactly what type of information will be collected from your therapist. Usually your insurance company will want to know when you came to session, what type of session you were in (couples, family or individual) and how long the session was (30 minutes, 45 minutes, 50 minutes or more).
Other insurance companies want a treatment plan (a specific written down plan of what goals you’ll be working on in session and how long it’ll take to complete the goals). Sometimes they want to know how exactly the therapist plans to help you reach your goal.
Still, some other insurance companies ask for more specific information about your sessions. Some might at some point ask to see the therapist’s notes or perhaps their initial assessment note. To protect your privacy, ensure that you have a good understanding of the information that is passed between the therapist and the insurance company, so that only what you’re comfortable with gets shared.
3) Your insurance company typically requires a diagnosis
Most insurance companies require a mental health diagnosis before they can pay for your sessions. This means your therapist has to diagnose you with a mental health condition in order for the services to be paid for. As a consumer of services you can ask your therapist, psychologist or counselor what he or she has diagnosed you with. Sometimes your diagnosis changes as you work longer with your therapist. These are all discussions that you can have with your therapist.
Some insurance companies will only pay for ‘Mild’ diagnoses, while others only pay for ‘Moderate to severe’ diagnoses. This mental health diagnosis becomes a part of your permanent record, so it’s important that you remain informed about this so that it doesn't affect you in the future.
Some people choose not to go the insurance route because they do not want to have a diagnosis on their record because of the nature of the work they do or because of work they might do in the future. Others choose not to have a diagnosis for other personal reasons. Neither is wrong or right. You pick which works for you.
4) They determine the type and number of sessions
Your insurance company usually decides how many sessions you need, the types of sessions you can utilize, as well as how long these sessions are. For example. they can decide that you only get 6 45-minute sessions. Now some insurance companies are flexible and if the therapist is able to put in a good justification for additional services, they’ll cover it. And with other insurance companies, you simply get what you get.
Some insurance companies are very generous and they’ll pay for 6 months, 1 year or even many years worth of therapy. The struggle with this is that the insurance company often has the power over what your treatment could look like. It’s important to be informed about how many sessions you can have so that your mental health care isn’t abruptly cut short.
5) Your therapist’s job doesn't stop after your session is over
When you use your insurance to cover therapy sessions, typically your therapist is spending time on the phone with your insurance company, sometimes going back and forth with them. Sometimes faxes are sent back and forth and additional paperwork has to be sent. So when you go into session, your therapist most definitely spends much more time than the 30 to 60 minutes you spend sitting in their office. However, insurance companies only pay therapists for the face to face time they spend with you.
6) Insurance doesn’t always pay for tele therapy or couples therapy
As life gets busy, some people prefer online therapy. And if you live in the Temecula area, you know that traffic gets a lot heavier at certain times of the morning and evening. To prevent sitting in traffic, many people prefer online therapy or counseling. As a licensed marriage and family therapist in California, my license allows me to see clients all over California. So you can sit in your home in Orange County or Los Angeles, log in to my online portal from your phone, tablet or laptop and participate in therapy from the comfort of your home or office. Some people even sit in their parked car and log into their counseling session.
Well, it’s important to first check with your insurance company. More and more insurance panels understand the benefits of online or distance therapy- especially in large cities in California. But some have still not moved with the times. Some will only cover phone sessions, while others only cover sessions when you drive to the therapist’s office.
Another type of therapy that is often not covered by insurance is couples or marriage counseling. Although the divorce rates are sky rocketing each day and more and more couples are open to speaking to a therapist to improve their relationship, not all insurance companies are willing to cover couples therapy. It’ll be important to check with your insurance company to see if they will be willing to help you out with the cost of therapy.
Are there any of the above points that took you by surprise? Comment below.
And if you’re ready to get rid of your anxiety or insomnia or begin marriage counseling in Murrieta, click here for your free 15-minute consultation call. I also provide therapy services online for people who live throughout California.
