Insurance

Understanding Your Plan

Depending on your plan, it is possible for counseling services to be covered in full or in part. Please contact your provider to verify your coverage. The following questions may be helpful when contacting your insurance provider:

  • Does my health insurance plan include mental health benefits?

  • Do I have a deductible? Have I met it yet?

  • Does my plan limit the number of sessions? What is the limit?

  • Do I need a written referral from my primary care physician for counseling services?

What are the pros of using insurance for therapy?

  • Lower Out-of-Pocket Costs. If your plan covers counseling, your out-of-pocket expenses, such as copays or coinsurance, may be reduced. Insurance can help alleviate some of the cost of therapy.

  • Affordable for Individuals/Families with Medical Concerns. If you have ongoing medical issues, therapy becomes more affordable once you reach your deductible.

What are the cons of using insurance for therapy?

  • High Deductibles. For clients with high deductibles, the cost of therapy may remain high until late in the year when the deductible is met, and then it resets the following year.

  • Less Flexibility with Payment Arrangements. Therapists are contractually obligated to adhere to insurance rates and structures.  

  • Limitations and Restrictions. Insurance companies use in-house auditors to determine eligible diagnosis, treatments plans and number of sessions.

  • Privacy and Confidentiality. Your diagnosis and treatment become part of your medical record, and your insurance company will have access to your record.

  • A diagnosis is required for coverage. Authorization of coverage and justification for services is dependent upon having a mental health diagnosis - this includes couple/family therapy. When using insurance for couple/family therapy, one person will need to be identified as “the client”. The identified client’s diagnosis is used to justify couple/family therapy. Let’s look at some of benefits and concerns with regard to mental health diagnosis:

Benefits.

  • If you meet criteria for a mental health diagnosis, you may have greater access to treatment and support.

  • A diagnosis can offer some clarity about symptoms. Having a label/name for your experiences can reduce stress.

  • It provides medical professionals with a common language and framework for treatment.

  • It can be helpful for those seeking educational or vocational assistance.

Concerns.

  • Over-Medicalization of the Human Experience.

    • When we adopt a purely medical model for mental health it can lead to an over-simplification of complex challenges.

    • Diagnosis does not offer insight about the root cause(s). And, the impact of societal and familial systems is often minimized causing stigmatization of the individual.

    • Over-Diagnosis and Over-Treatment. The term “disease mongering” has been used by some to convey a growing frustration about pathologizing typical life experiences. The U.S. CDC, as well as the Canadian government, have acknowledged a significant increase in children diagnosed with mental disorders and placed on medication (a 41% increase over the last decade), deepening concerns about labeling some child behavior(s) as pathological. (https://pmc.ncbi.nlm.nih.gov/articles/PMC3665855/) .

  • Ethical Considerations. While the DSM-5 (our diagnostic Bible for mental health) is subject to extensive review and input, a couple concerns persist.

    • Some mental health professionals see the nondisclosure of financial conflicts-of-interest between review committee members and the pharmaceutical industry as problematic (Davis, et al, 2023). Recent criticism centers on the broadening and marketing of diagnostic categories as contributing to a greatly expanded patient population and the over-prescription of medication.

    • Another growing concern is that mental health, when conceptualized through a “Western or Eurocentric” lens, discounts (or worse pathologizes) cultural differences and enables systems of oppression (Mullan, 2023).

  • Diagnostic Variability. Diagnoses can vary greatly from one therapist to another. Unlike medical doctors, there are no blood tests or scans for diagnosing mental illness. Diagnosis depends on self-reports, observation, interviews and rating scales. The human experience does not fit neatly into prescribed categories and symptoms can overlap with multiple diagnoses. At times, it can feel like we are trying to fit a uniquely shaped set of experiences into a standard square hole. Lastly, trends in diagnosis (and treatment) vary and are influenced by popularity, education and biases within the field.

References / Further Reading

  • Boyd, E. & Bero, L. (2000). Assessing faculty financial relationships with industry. JAMA, 284, 2209–2214.

  • Davis, L., Diianni, A., Drumheller, S., et al. (2023). Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis. BMJ, 384, e076902.

  • Cosgrove L, D'Ambrozio G, Herrawi F, Freeman M and Shaughnessy A (2023) Why psychiatry needs an honest dose of gentle medicine. Front. Psychiatry 14:1167910. doi: 10.3389/fpsyt.2023.1167910\
    Melander, H., Ahlqvist-Rastad, I., Meijer, G., et al. (2003). Evidence b(i)ased medicine – selective reporting from studies sponsored by the pharmaceutical industry. BMJ, 326, 1171–1173.

  • Mullan, J. (2023). Decolonizing therapy: oppression, historical trauma, and politicizing your practice. W. W. Norton