While medical insurance is a necessity for most of us, you may want to consider the following if you decide to use it for mental health care.
1. Potential loss of confidentiality.
An insurance claims specialist technically has the right to access any and all information including progress notes which may contain details of what occurred during your sessions. The therapist’s records can be audited at any time and the insurance company has full access to any details your therapist might have including information intentionally not included in the claim. The insurance company will want information about the type of treatment you are receiving and whether or not you’re improving (since their goal is to stop paying as soon as possible). In addition, most claims pass through a dozen or so people when being processed, all of whom now have access to your information.
2. Existence of a mental health disorder.
Insurance will cover only that which is “medically necessary” which means I would have to give you a diagnosis of a mental health disorder from the Diagnostic and Statistical Manual. If your situation doesn’t warrant a diagnosis, then I am ethically bound to not invent one just for the sake of insurance coverage.
3. Creates a pre-existing condition.
Once an insurance company determines the existence of a “medical necessity” and significant impairment, this creates a pre-existing condition which may cause higher premiums, deductibles, or co-pays in the future. Any diagnosis made in therapy can become a part of your permanent medical record.
4. Loss of control of treatment.
Most insurance companies require a treatment plan to be submitted in order to approve the number of sessions in advance. This is approved by a claims specialist, not necessarily you and your therapist, and is not based on need or changing circumstances.
5. You lose the control of choosing a specialist in the area you want to work on.
Therapists on insurance panels are not able to turn away clients because their needs do not fall under the therapist’s area of expertise. Therapists are expected to be generalists (much like your GP) and be able to treat anyone and everyone but this is usually not the reality.