THERAPY AND INSURANCE
When most people think about going to a therapist, they worry about how much those services will cost them. If they do have insurance, they wonder if their insurance company will even pay for counseling. If they don’t have insurance, they worry about how they can afford those services. If this is your situation, I would like to describe how insurance works so you can become better informed about the process.
The role of diagnosis
All insurance companies pay for services based on what the diagnosis is. The diagnosis system used by the insurance companies comes from a classification system called The Diagnostic and Statistical Manual Of Mental Disorders. For more information, you can go to http://en.wikipedia.org/wiki/DSM-5. Insurance companies reimburse the therapist if the diagnosis is a “medical necessity”. In other words, they won’t pay for career counseling, stress reduction or self exploration, unless there is an underlining emotional or medical concern. This can be confusing when you want to see a therapist for a couple’s or family therapy. As stressful as marriage and family issues can be, insurance companies do not consider them medical problems. The way couples or families get coverage is by identifying one of the members as the client. That way, the insurance company will reimburse on that individual’s diagnosis. So it is important that you understand from your therapist who is the identified client and what the diagnosis will be. Your therapist knows how the insurance companies work and will handle most of this for you.
For most people, using insurance is still the best way to help them with the cost of counseling. Your insurance company will help you understand what your policy covers and what your co-pay is. Then when you meet with your counselor you can discuss what your diagnosis will be so you can be comfortable with what it is.
If you don’t have insurance or don’t want to use your insurance, I advise you to discuss this with your new therapist to see what options are available.
I am very willing to discuss any further questions you may have regarding insurance.